title: Anaphylactic reactions on the beach: a cause for concern?
abstract: BACKGROUND
  The commonest causes of anaphylaxis include hymenoptera bites, high-risk food, exercise, and jellyfish bites and may often be encountered on the beach. Therefore, millions of visitors at popular touristic locations are exposed to increased risk of anaphylactic reactions every year. At least 35 cases of acute allergic reactions requiring medical attention took place on the beaches of Crete, Greece during the previous summer.
  
  
  OBJECTIVE
  To evaluate the level of training of lifeguards working on the beaches of the island of Crete, Greece, with regard to emergency management of anaphylaxis as well as to assess the sufficiency of medical equipment that lifeguards possess to treat an anaphylactic reaction.
  
  
  METHODS
  A questionnaire was prepared by the authors and administered to 50 lifeguards working on various beaches of Crete. Queries included the definition of anaphylaxis, proper medical treatment, and the existence or not and composition of an emergency kit with regard to the management of acute allergic reactions.
  
  
  RESULTS
  Our series consisted of 50 lifeguards, 39 (78%) male and 11 female (22%). Although 41 (80%) lifeguards were aware of an acceptable definition of anaphylaxis, no one knew that epinephrine is the first-choice treatment, and 32 (60%) lifeguards replied that steroids should be used for emergency treatment. Additionally, no one possessed an emergency kit that would qualify for management of acute allergic reactions.
  
  
  CONCLUSIONS
  The beach should be considered as a high-risk place for the appearance of anaphylactic reactions. Lifeguards who would be the first trained personnel to encounter this condition should be sufficiently trained and equipped for emergency treatment. Our department is currently introducing a training program to local authorities for the proper training and equipping of lifeguards in the island of Crete.
authors.affiliation: Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Karatzanis
authors.forename: Constantinos A
authors.initials: CA
authors.lastname: Bourolias
authors.forename: Emmanuel P
authors.initials: EP
authors.lastname: Prokopakis
authors.forename: Irini
authors.initials: I
authors.lastname: Shiniotaki
authors.forename: Irini E
authors.initials: IE
authors.lastname: Panagiotaki
authors.forename: George A
authors.initials: GA
authors.lastname: Velegrakis