Patients with systemic mastocytosis (SM) and other mast cell disorders may require a lower threshold for epinephrin administration in the case of anaphylaxis, according to a recent study published in the Journal of Allergy and Clinical Immunology.
Epinephrin should always be administered to individuals experiencing anaphylaxis, the authors emphasized. However, due to variation in symptoms and speed of onset it can sometimes be difficult to determine if someone is facing anaphylaxis.
A group of 34 experts in anaphylaxis convened to develop recommendations for providing epinephrin and activating emergency medical services (EMS). Their goal was to create guidelines that are more specific to individual patient circumstances than existing recommendations.
The study defined consensus agreement as agreement of at least 70% and consensus disagreement as disagreement of at least 90%. Overall, 88.2% of panelists agreed that having a history of mast cell disorders such as SM may lower the threshold for epinephrin use.
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The panel ultimately decided that individuals with mast cell disorders should receive epinephrin when experiencing moderate skin or mucosal symptoms (70.6% agreement). However, only 8.8% felt that patients with mast cell disorders should take epinephrin for mild skin or mucosal symptoms or for mild gastrointestinal symptoms.
The panel also suggested that those who have previously received at least two doses of epinephrin should be given epinephrin for moderate skin or mucosal symptoms.
Other factors that may warrant a lower epinephrin threshold included a diagnosis of asthma, contact with a known or suspected allergen and being more than 30 minutes away from the closest hospital.
Additionally, the experts decided that EMS should be called when individuals are alone or without someone to administer epinephrin, have previously received at least two doses of epinephrin, do not have a second epinephrin device or are more than 30 minutes away from the nearest hospital.
Individuals should also contact EMS before administering epinephrin if they are experiencing severe cardiovascular, neurologic or respiratory symptoms. If these symptoms arise after the first dose of epinephrine, or if cardiovascular or neurologic symptoms are mild to moderate, EMS should be activated, the panel stated.
“Integrating these recommendations into patient-facing technologies may help optimize epinephrine use, prevent under- and over-treatment, support appropriate healthcare utilization, and empower patient and caregiver self-efficacy during reactions,” the authors concluded.
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