American Academy of Allergy: Statement on resuscitative equipment

THE JOURNAL

OF

ALL-Y AND

VOLUME

67

NUMBER

1

Armriwn Academy, of Aiiergy: Statement on resuscit8tire eqwipmewt

PmITION

STATEMENT

so as to avoid and minimize reaction; (2) recognition and treatment of local reactions to allergenic extracts; (3) recognition and treatment of systemic rractions to allergenic extracts; and (4) basic cardiopulmonary resuscitation. The following equipment and reagents should be available: (I) stethoscope. and sphygmomanometer; (2) tourniquets. syringes, hypodermic needles. and large-bore needles ( 14-gauge); (3) aqueous epinephrine HCI 1 : 1,000; (4) equipment for administering oxygen hy mask; (5) equipment for administering intravenous fluids; (6) oral airway; (7) diphenhydramine or similar antihistamine; (8) aminophylline for intravenous injection; (9) corticosteroids for intravenous injection; and (10) vasopressor. The proper use of these personnel, tools, and rcagents should provide effective ititial treatment for most, if not all, systemic reactions to ailergenic extracts. The prompt recognition of systemic reactions and the immediate use of epinephrine are the mainstay of therapy.

Th: Executive Committee of the American Academy c)f Allergy has considered the implications of the following statement on the package insert for hymenoptera venoms: Becauseof the possibility of severe systemic reactions, the patient should be fully informed hy Ilie physician of the risks involved and should be u!lder his constant supervision. The venom prepstations should be used only in settings where emergency resuscitative equipment and trained l:~~rsonnclare immediately available to treat such n:actions.* The risks of systemic reaction from a proper immunizing dose of Hymenoptera venom are similar to those from a proper immunizing dose of pollen or othex allergenic extract of an inhaled allergen. The dose of allergenic extract that has been shown to be effective for immunotherapy is one that carries a risk of systemic reaction in the patient allergic to that extract. Appropriate adjustment of the dose will reduce the incidence and severity of these reactions but, nevertheless, some will inevitably occur. Therefore. the above warning applies to immunotherapy with all allergenic extracts and is not restricted solely to venom preparations. Reauscihtive

equipment

Procedures There are several invasive procedures that may be needed, although only rarely, for treatment of systemic reactions. These include ( 1) direct laryngoscopy, (2) direct current cardioversion (electrical countershock), (3) tracheotomy, and (4) intracardiac injection of drugs. The rare situation in which these procedures might be essential does not justify the risk of their being made available for use under less-than-ideal circumstances. Therefore, it is neither necessary nor practical to insist that these procedures be immediately available to personnel using allergenic extracts.

and personnel

The “trained personnel . immediately available ’ should include personnel who are familiar with the tollowing procedures: (1) adjustment of dose of allefgenic extract for skin testing and immunotherapy “Prc~uct infornutwn wa;. N. J.

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