title: Addressing barriers to emergency anaphylaxis care: from emergency medical services to emergency department to outpatient follow-up.
abstract: BACKGROUND
  Anaphylaxis is a systemic life-threatening allergic reaction that presents unique challenges for emergency care practitioners. Allergists and emergency physicians have a history of collaborating to promote an evidence-based, multidisciplinary approach to improve the emergency management and follow-up of patients with or at risk of anaphylaxis.
  
  
  OBJECTIVE
  To review recent scientific literature about anaphylaxis, discuss barriers to care, and recommend strategies to support improvement in emergency anaphylaxis care.
  
  
  METHODS
  An expert panel of allergists and emergency physicians was convened by the American College of Allergy, Asthma and Immunology in November 2014 to discuss current knowledge about anaphylaxis, identify opportunities for emergency practitioners and allergists to partner to address barriers to care, and recommend strategies to improve medical management of anaphylaxis along the continuum of care: from emergency medical systems and emergency department practitioners for acute management through appropriate outpatient follow-up with allergists to confirm diagnosis, identify triggers, and plan long-term care.
  
  
  RESULTS
  The panel identified key barriers to anaphylaxis care, including difficulties in making an accurate diagnosis, low rates of epinephrine administration during acute management, and inadequate follow-up. Strategies to overcome these barriers were discussed and recommendations made for future allergist/emergency physician collaborations, and key messages to be communicated to emergency practitioners were proposed.
  
  
  CONCLUSIONS
  The panel recommended that allergists and emergency physicians continue to work in partnership, that allergists be proactive in outreach to emergency care practitioners, and that easy-to-access educational programs and materials be developed for use by emergency medical systems and emergency department practitioners in the training environment and in practice.
authors.affiliation: Emory University School of Medicine and Atlanta Allergy and Asthma Clinic, Atlanta, Georgia.
authors.forename: Stanley M
authors.initials: SM
authors.lastname: Fineman
authors.affiliation: Department of Emergency Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Bowman
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ronna L
authors.initials: RL
authors.lastname: Campbell
authors.affiliation: Division of Allergy, Asthma & Immunology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Paul
authors.initials: P
authors.lastname: Dowling
authors.affiliation: Public Communications Inc., Chicago, Illinois. Electronic address: dorourke@pcipr.com.
authors.forename: Dianne
authors.initials: D
authors.lastname: O'Rourke
authors.affiliation: Division of Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: W Scott
authors.initials: WS
authors.lastname: Russell
authors.affiliation: Family Allergy and Asthma, Louisville, Kentucky.
authors.forename: J Wesley
authors.initials: JW
authors.lastname: Sublett
authors.affiliation: Department of Medicine, Nova Southeastern University, Fort Lauderdale, Florida.
authors.forename: Dana
authors.initials: D
authors.lastname: Wallace
mesh_terms: D000707:Anaphylaxis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D032921:Consensus; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D010045:Outpatients; D053802:Tryptases / Q000097:blood*
chemical_list: D053802:Tryptases; D004837:Epinephrine