From the Guidelines
Following hospitalization for a new anaphylaxis diagnosis, primary care follow-up should include referral to an allergist/immunologist for comprehensive evaluation and management, as recommended by the most recent guidelines 1. The patient should be prescribed an epinephrine auto-injector with instructions to carry it at all times and use it immediately for symptoms of anaphylaxis. Two auto-injectors should be prescribed, as a second dose may be needed while awaiting emergency services. Specific testing recommended includes:
- Skin prick testing and/or serum-specific IgE testing to identify potential triggers based on the patient's history.
- A serum tryptase level, ideally drawn within 3 hours of the anaphylactic episode, can help confirm the diagnosis and rule out mastocytosis if elevated at baseline, as suggested by previous guidelines 1. The primary care provider should educate the patient on:
- Trigger avoidance
- Recognition of early symptoms
- Create an anaphylaxis action plan Medical alert identification should be recommended. Follow-up appointments should be scheduled at 3-6 month intervals initially to assess medication adherence, review the action plan, and address any concerns. This comprehensive approach is essential because anaphylaxis is a potentially life-threatening condition, and proper management significantly reduces the risk of recurrence and ensures prompt treatment if it does occur, as emphasized by the importance of prompt epinephrine administration in anaphylaxis management 1. Referral to an allergist/immunologist is crucial for patients with anaphylaxis, as they can provide detailed history, coordinate allergy diagnostic testing, evaluate the benefits and risks of therapeutic options, and counsel the patient on avoidance measures, as outlined in previous practice parameters 1.
From the Research
Testing for Anaphylaxis
- Patients who have experienced anaphylaxis should undergo testing to identify the specific allergen responsible for the reaction 2, 3.
- This may include allergen skin testing and in vitro assay for serum immunoglobulin E of specific allergens, although these tests do not reliably predict who will develop anaphylaxis 2.
- Timed blood samples should be taken for the mast cell tryptase (MCT) test as soon as possible after successful emergency treatment, with serum samples taken within 1-2 hours but no later than 4 hours from the onset of symptoms 3.
Referrals for Anaphylaxis
- Referral to a specialist allergy service (or specialist pediatric service) is strongly recommended for patients who have experienced anaphylaxis 3, 4.
- An adrenaline injector device for intramuscular use only should be prescribed as an interim measure before referral to a specialist allergy clinic 3.
- Patients should be educated about the appropriate use of prescription epinephrine autoinjectors and the importance of carrying them at all times 2.
Follow-up Care for Anaphylaxis
- Patients who have experienced anaphylaxis should be observed for 6-12 hours after the onset of symptoms to monitor for potential relapse 3.
- Children under 16 years should be admitted and supervised by a pediatrician 3.
- Follow-up care with an allergist/immunologist is important, but studies have shown that many patients do not receive subsequent care with an allergist/immunologist after an anaphylaxis event 5, 6.