Anaphylaxis: Diagnosis and Management in the Rural Emergency Department

It is not uncommon for patients to present to a rural emergency department with one of the syndromes of anaphylaxis: urticaria, angioedema, and severe anaphylaxis. Therefore, it is important for the rural health care provider to be able to recognize these anaphylaxis syndromes and manage them appropriately. Urticaria and/or angioedema may present as isolated entities or may be combined with asthma and/or hypotension to produce severe anaphylaxis. The mainstays of treatment of urticaria are the H1 and H2 receptor anatagonists, most effective when given in combination intravenously. Acute angioedema may occur with or without urticaria and is treated with epinephrine. In severe anaphylaxis, urticaria and/or angioedema are accompanied by acute bronchospasm and or hypotension. Immediate therapy with parenteral epinephrine as well as rapid fluid resuscitation is critical for its successful management. Patients with angioedema or severe anaphylaxis should be given epinephrine auto-injectors prior to discharge. Follow-up with an allergist is recommended for most patients with anaphylaxis.