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Anaphylaxis:
After treating the acute anaphylactic reaction, the clinician ’s next task is to prevent a recurrence. The patient should be observed in the ED. How long this observation period should last depends on their clinical course, risk factors, and social support. All patients should be discharged with a prescription for 2 epinephrine autoinjectors and counseled on appropriate use. The patient should also receive education on the signs and symptoms of anaphylaxis and avoiding triggers. The patient should follow-up with an allergy specialist who can confirm triggers and provide immunotherapy as indicated. (Source: Emergency Medi...
Source: Emergency Medicine Clinics of North America - November 2, 2021 Category: Emergency Medicine Authors: Nicholas P. Gorham Source Type: research

Mimics of Allergy and Angioedema
Scombroid poisoning, systemic mastocytosis, and hereditary alpha tryptasemia all present with episodes that resemble allergic reactions. Knowledge regarding systemic mastocytosis and hereditary alpha tryptasemia is quickly evolving. Epidemiology, pathophysiology, and strategies to identify and diagnose are discussed. Evidence-based management in the emergency setting and beyond is also explored and summarized. Key differences are described between these events and allergic reactions. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 1, 2021 Category: Emergency Medicine Authors: Elizabeth G. Thomas, Daniel James Thomas Source Type: research

Anaphylaxis
is a potentially life-threatening, multisystem allergic reaction that can cause airway, breathing, or circulatory compromise. Intramuscular epinephrine is the immediate treatment of all patients. Intravenous epinephrine should be used in patients in shock, either as a bolus or infusion, along with fluid resuscitation. Airway obstruction must be recognized, and early intubation may be necessary. For shock that is refractory to epinephrine, additional vasopressors may be needed. Disposition depends on patient presentation and response to treatment. Mandatory observation periods are not necessary, because biphasic reactions ...
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: Kelly McHugh, Zachary Repanshek Source Type: research

Spondyloarthritides
The spondyloarthritides are a diverse group of distinct yet interrelated disease processes with overlapping clinical features. They are ankylosing spondylitis, reactive arthritis, inflammatory bowel disease –associated arthritis, and psoriatic arthritis. Genetically, these disease processes have been linked by the presence of HLA-B27. They manifest with axial and peripheral symptoms, such as inflammatory back pain, enthesitis, oligoarthritis, and dactylitis. The onset of symptoms can begin before the age of 45; however, because of the wide range of signs and symptoms, diagnosis can be delayed, leading to unchecked inflam...
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: Hope A. Taitt, Rithvik Balakrishnan Source Type: research

Overview of Allergy and Anaphylaxis
Allergic reactions and anaphylaxis occur on a severity continuum from mild and self-limited to potentially life-threatening or fatal reactions. Anaphylaxis is typically a multiorgan phenomenon involving a broad range of effector cells and mediators. Emergency department visits for anaphylaxis are increasing, especially among children. There is a broad differential diagnosis for anaphylaxis, and the diagnosis of anaphylaxis can be aided by the use of the National Institutes of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network clinical diagnostic criteria. Risk factors for severe anaphylaxis include older a...
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: Timothy E. Dribin, Megan S. Motosue, Ronna L. Campbell Source Type: research

Evaluation and Management of Food Allergies in the Emergency Department
Food allergies are a common and serious cause of illness, accounting for an increasing number of emergency department visits annually. Although definite diagnosis lays outside of an emergency department visit, the clinical management of the most serious food allergies highlights emergency care. The staple of acute care remains epinephrine in association with antihistamines and steroids. The greatest threat remains undertreatment for this group of disorders and underutilization of epinephrine. Those who have been treated for a food allergy need a follow-up allergist evaluation, guidance of food avoidance, and avoidance of f...
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: Genevieve Schult Krajewski, Thomas Krajewski Source Type: research

Allergic Acute Coronary Syndrome —Kounis Syndrome
Acute coronary syndrome (ACS) in the setting of an allergic/immunologic reaction is known as Kounis syndrome. It is an underdiagnosed and underrecognized disease entity. One must keep a high index of suspicions when managing a patient presenting with cardiac as well as allergic symptoms. There are 3 main variants to the syndrome. Treating the allergic reaction may alleviate the pain; however, ACS guidelines should be followed if cardiac ischemia is present. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: Leen Alblaihed, Maite Anna Huis in ‘t Veld Source Type: research

Immune-based Therapies —What the Emergency Physician Needs to Know
This article provides a review of the mechanisms of action, indications for use, and potential complications of immunotherapy treatments that are relevant in the emergency care setting. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: Sarah B. Dubbs, Cheyenne Falat, Lauren Rosenblatt Source Type: research

Sarcoidosis
has a multitude of manifestations and affects the human body widely. Pulmonary complaints are most common; however, cardiac, optic, and neurologic manifestations carry high mortality and morbidity. Acute presentations in the emergency room can cause life-altering effects if not appropriately diagnosed and treated. Generally, less severe cases of sarcoidosis have a favorable prognosis and can be treated with steroid therapy. Resistant and more severe cases of the disease carry high mortality and morbidity. It is incredibly important to arrange specialty follow-up for these patients when needed. This review focuses on the a...
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: Denrick Cooper, Salvador Suau Source Type: research

Drug Hypersensitivity Reactions
Drug hypersensitivity reactions are a diverse group of reactions mediated by the immune system after exposure to a drug. The Gell and Coombs classification divides immunologic DHRs into 4 major pathophysiologic categories based on immunologic mechanism. Anaphylaxis is a Type I hypersensitivity reaction that requires immediate recognition and treatment. Severe cutaneous adverse reactions (SCARs) are a group of dermatologic diseases that result from a Type IV hypersensitivity process and include drug reaction with eosinophilia and systemic symptom (DRESS) syndrome, Stevens –Johnson Syndrome (SJS), toxic epidermal necrolysi...
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: R. Gentry Wilkerson Source Type: research

Hereditary Angioedema
Hereditary angioedema (HAE) is a rare autosomal dominant genetic disorder that usual results from a decreased level of functional C1-INH and clinically manifests with intermittent attacks of swelling of the subcutaneous tissue or submucosal layers of the respiratory or gastrointestinal tracts. Laboratory studies and radiographic imaging have limited roles in evaluation of patients with acute attacks of HAE except when the diagnosis is uncertain and other processes must be ruled out. Treatment begins with assessment of the airway to determine the need for immediate intervention. Emergency physicians should understand the pa...
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: R. Gentry Wilkerson, Joseph J. Moellman Source Type: research

Autoimmune Connective Tissue Diseases: Systemic Lupus Erythematosus and Rheumatoid Arthritis
Systemic lupus erythematosus and rheumatoid arthritis are just 2 of several autoimmune connective tissue diseases that are primarily chronic in nature but can present to the emergency department by virtue of an acute exacerbation of disease. Beyond an acute exacerbation of disease, their predilection for invading multiple organ systems lends itself to the potential for patients presenting to the emergency department with either a single or isolated symptom or a myriad of signs and/or symptoms indicative of a degree of disease complexity and severity that warrant timely recognition and resuscitation. (Source: Emergency Medi...
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: Jonathan Rose Source Type: research

Angiotensin-Converting Enzyme Inhibitor –Induced Angioedema
Angioedema is a well-recognized and potentially lethal complication of angiotensin-converting enzyme inhibitor (ACEi) therapy. In ACEi-induced angioedema, bradykinin accumulates due to a decrease in its metabolism by ACE, the enzyme that is primarily responsible for this function. The action of bradykinin at bradykinin type 2 receptors leads to increased vascular permeability and the accumulation of fluid in the subcutaneous and submucosal space. Patients with ACEi-induced angioedema are at risk for airway compromise because of the tendency for the face, lips, tongue, and airway structures to be affected. The emergency phy...
Source: Emergency Medicine Clinics of North America - October 29, 2021 Category: Emergency Medicine Authors: R. Gentry Wilkerson, Michael E. Winters Source Type: research

Approach to Abdominal Imaging in 2022
This article introduces the commonly available modalities, discusses the advantages and disadvantages, and presents current recommendations for commonly diagnosed conditions. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 30, 2021 Category: Emergency Medicine Authors: Daniel S. Brenner, Tiffany C. Fong Source Type: research

Gastrointestinal Emergencies
Numerous studies have quantified our observed reality on a shift in the emergency department: abdominal pain, nausea, vomiting, diarrhea, and constipation are common, and, at times, the definitive cause of these signs and symptoms is challenging to diagnose. The breadth of conditions that present with abdominal complaints varies widely from the benign to acutely life-threatening; from the clearly gastrointestinal in origin to manifestations of extraintestinal pathologic conditions; from chronic and lingering to rapidly progressive. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 30, 2021 Category: Emergency Medicine Authors: Sara Manning, Nicole McCoin Tags: Preface Source Type: research