Managing allergy, anaphylaxis: AAP releases customizable emergency plan
JulieWang, M.D., FAAP
AAP Clinical Report
For the first time, the Academy is presenting a written emergency plan for allergy
and anaphylaxis that can be individualized for use by patients, families, health care
professionals and schools. The plan is included in one of two clinical reports from
the Section on Allergy and Immunology that aim to enhance the care of children at
risk for allergic reactions.
The emergency plan was created with the support and advice of multiple AAP committees,
councils and sections, and was evaluated to ensure it meets health literacy recommendations.
For patients at risk for anaphylaxis, the provision of emergency action plans and
prescriptions for epinephrine auto-injectors are recommended by national and international
anaphylaxis guidelines, as well as several AAP clinical reports and policies (see
resources). The key to managing allergic reactions, including anaphylaxis, is the
recognition of the signs and symptoms and prompt initiation of treatment.
Numerous studies have noted that patients, families and schools are not prepared to
manage allergic reactions. Thus, a standardized, written allergy and anaphylaxis emergency
plan is an essential component of the clinical care of these patients. Currently,
several anaphylaxis action plans are available, but their use by health care professionals
varies. An objective of the AAP emergency plan is to promote greater familiarity with
and utilization of a single plan to improve patient care.
Health care providers should develop these individualized plans with their patients
and families and counsel them on the importance of sharing the plans with family and
nonfamily caregivers and school personnel.
Using the plan
Since allergic reactions can be unpredictable, the treatment pathways outlined in
the plan cover mild to severe reactions. The plan emphasizes that if there is any
uncertainty about the severity of an allergic reaction, epinephrine should be used
promptly since this life-saving medication is the first-line treatment for anaphylaxis.
The plan also allows for the use of other medications (if desired and permitted by
school or local policies) for the initial management of mild allergic reactions that
are not anaphylaxis. For those with a history of near-fatal anaphylaxis or other risk
factors for severe anaphylaxis, the plan can indicate that epinephrine should be used
at the first sign of any symptom. Scenarios in which to consider these options are
further discussed in the clinical report.
The form also includes appropriate medication dosages and indications for additional
medications such as a second dose of epinephrine. In addition, instructions for contacting
emergency medical services and monitoring for progression of symptoms are included.
The written plan is only one aspect of comprehensive management of allergy and anaphylaxis.
General education and planning for prevention, recognition and management of anaphylaxis
also are needed.