Commentary on Japanese Guidelines for Food Allergy 2021 Chapter 7 Evaluation and treatment of immediate reaction

Abstract

Anaphylaxis is an acute, life-threatening systemic allergic reaction that may have a wide range of clinical manifestations. Majority of anaphylaxis reactions are not life-threatening; however, due to our inability to predict its severity, all anaphylaxis must be appropriately treated with intramuscular adrenaline. Adrenaline is the first-line pharmacotherapy for anaphylaxis, and diagnosis and management must occur rapidly. H1-antihistamines relieve itching but do not relieve life-threatening symptoms; therefore, like H2-receptor antagonists and glucocorticoids, they are adjunctive treatments and not appropriate as initial and lone treatments. Adrenaline auto injector is indicated for individuals who have a history or risk for anaphylaxis. They should be taught how to inject and equipped with a written anaphylaxis emergency action plan that aids them to recognize symptoms. The occurrence of unintentional injection of adrenaline from auto injectors is increasing. They need regular instructions on how to use adrenaline auto injectors correctly and safely.