Management of Anaphylaxis in Patients with History of Hazelnut Allergy

Immediate Management

The American Academy of Pediatrics recommends administering epinephrine immediately as the drug of choice for anaphylaxis, with a dose of 0.3 mg IM in the anterolateral thigh for adults 3, 4
The American Academy of Pediatrics suggests observing patients for at least 4-6 hours after treatment, as biphasic reactions can occur in 1-20% of anaphylaxis cases 3
The American College of Allergy, Asthma, and Immunology recommends providing supplemental oxygen and rapid volume expansion with crystalloids or colloids if the patient shows signs of cardiovascular compromise 1
Consider adjunctive treatments such as H1-antihistamines, H2-antihistamines, and corticosteroids, though these should not replace or delay epinephrine administration, as recommended by the American Academy of Pediatrics 3

The American Academy of Pediatrics recommends prescribing two doses of epinephrine autoinjector for the patient to carry at all times 3, 5
Provide proper instruction for self-administration of epinephrine, as recommended by the American College of Allergy, Asthma, and Immunology 1, 6
Create an anaphylaxis emergency action plan, as suggested by the American Academy of Pediatrics 3
Arrange for follow-up evaluation with an allergist-immunologist, as recommended by the American College of Allergy, Asthma, and Immunology 1, 6

Refer to an allergist-immunologist for comprehensive evaluation to identify the trigger of the current reaction and assess cross-reactivity with other allergens, as recommended by the American College of Allergy, Asthma, and Immunology 1, 6
Perform skin prick tests to evaluate potential allergens, including tree nuts and related foods, as suggested by the American College of Allergy, Asthma, and Immunology 7
Consider oral food challenges in a controlled medical setting with personnel experienced in treating anaphylaxis to confirm specific allergies, as recommended by the American College of Allergy, Asthma, and Immunology 7, 6

Peanuts and tree nuts cause the majority of fatalities from food-induced anaphylaxis, as reported by the American Academy of Pediatrics 3

Delayed administration of epinephrine has been implicated in contributing to fatalities from anaphylaxis, as reported by the American Academy of Pediatrics 3
Many patients and caregivers fail to use epinephrine autoinjectors when anaphylaxis occurs, even for severe symptoms, due to various reasons including fear of needles or concerns about adverse effects, as reported by the American Academy of Pediatrics 8