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Anaphylaxis

Pathway Background and Objectives

Anaphylaxis is a multisystem emergency that can progress to a life threatening condition, and therefore requires prompt recognition and treatment. Leading causes of anaphylaxis are medications, foods, and Hymenoptera species (i.e. bees, wasps, hornets) stings. Delayed treatment with epinephrine is associated with increased risk for fatality. A clinical pathway can empower the early administration of epinephrine when anaphylaxis is suspected and also ensure adherence to national guidelines for management of anaphylaxis. The specific objectives of this clinical pathway are to:

  • Standardize the approach for patients with anaphylaxis
  • Improve the recognition of anaphylaxis and early administration of intramuscular epinephrine
  • Improve the safety of patients who develop anaphylaxis
  • Improve documentation of allergic reactions, including symptoms and severity of the reaction

Algorithm

Download Anaphylaxis Algorithm

Quality Metrics

  • Percentage of patients with utilization of pathway order set
  • Time from reaction (if in a clinic or hospitalized) or time from arrival to ED to administration of epinephrine (if not already given prior to arrival)
  • Percentage of patients on pathway with documentation of allergy AND reaction in chart
  • Number of patients discharged from the ED who return within 72 hours and 7 days

Educational Module

Download Anaphylaxis Educational Module

Key References

  1. Campbell RL, Li J, Nicklas RA, Sadosty AT. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014 Dec;113(6):599-608.
  2. Choo KJ, Simons E, Sheikh A. Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review. Allergy. 2010 Oct;65(10):1205-11.
  3. Lieberman P. Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol. 2005 Sep;95(3):217-26.
  4. Liberman P, Nicklas RA, Randolph C, et al. Anaphylaxis –  a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015 Nov;115(5):341-84.
  5. Shaker MS, et al. Anaphylaxis – a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020 April;145(4):1082-1123.
  6. Sheikh A, Ten Broeck V, Brown SG, Simons FE. H1-antihistamines for the treatment of anaphylaxis: Cochrane systematic review. Allergy. 2007 Aug;62(2):830-7.

Pathway Contacts

  • Katie Lord, BSN, Natalie Bezler, MD
    • Hematology Oncology
  • Ilana Waynik, MD
    • Pediatric Hospital Medicine
  • Eric Hoppa, MD
    • Pediatric Emergency Medicine

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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