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Development and implementation of national anaphylaxis guidelines

Speaker: Tomรกs Chivato

29 September 2012

Spanish anaphylaxis management guidelines: GALAXIA project Tomรกs Chivato Madrid, Spain

Disclosures Tomรกs Chivato, MD, PhD School of Medicine, CEU San Pablo University, Madrid โ€ข

Lecture fees: Fees from ALK

Objectives • Process of development of this guideline • Present output • Comment on dissemination and assessment of impact


Proyecto GALAXIA Gu铆a de Actuaci贸n en anafiLAXIA

The GALAXY project Guideline for the mAnagement of anaphyLAXis

• In 2007-2008 during WAO  survey

• No anaphylaxis guidelines in 13 of 44 (30% of) • Adrenaline ampules were universally available, 6 other essentials were not • We became “aware” of this necessity

7-11 June


Anaphylaxis guidelines (Sth Europe) • • • •

No Ongoing Yes No data

Why Spain as a “test case” for anaphylaxis guideline introduction? • No anaphylaxis guidelines • High number of allergists • Good scientific society structure


Spanish anaphylaxis guidelines • Focused on diagnosing, treating and long term management of anaphylaxis • Initially, developed mainly by allergists • Dissemination for use by allergists and other specialists • Both for adults and children • Based on previously published guidelines, relevant position papers, EBM,… 10

Road map for the elaboration and dissemination of the anaphylaxis guideline • Invitation to participate to emergency care societies and pediatric allergy representatives • First draft by end of April 2009 • Final document by September 2009 • Announcement at the SEAIC International Symposium October 2009 • Publication 2011 11

Task force group

• • • •

Dr. Nieves Cabañes (SEAIC) • Dr. Victoria Cardona (SEAIC) • Dr. Tomás Chivato (SEAIC) • Dr. Montserrat Fernández Rivas (SEAIC) • • Dr. Concepción Freijo (SEUP) • • Dr. Pedro Guardia (SEAIC) •

Dr. Belén de la Hoz (SEAIC) Dr. Teófilo Lobera (SEAIC) Dr. Santiago Nevot (SEAIC, SEICAP) Dr. Cristina Pascual (SEICAP) Dr. Arantza Vega (SEAIC) Dr. Pedro Villaroel (SEMES)




Guía de Actuación en anafiLAXIA • Available at, ,,,

• Submitted for publication in a general medical journal in Spanish • Survey to evaluate the impact 14

Key points • Until now there was no consensus guideline for anaphylaxis management in Spain

• The prevalence of anaphylaxis is increasing in Spain • Anaphylaxis is a severe allergic reaction which is rapid in onset and might lead to death • Anaphylaxis usually presents with skin symptoms such as urticaria and angioedema together with the involvement of other organs such as the respiratory, cardiovascular or digestive system. 15

• Intramuscular adrenaline is the treatment of choice of anaphylaxis in any setting, and it has to be administered early • Serum tryptase is a useful marker in the diagnosis of anaphylaxis • Any patient at risk of suffering an anaphylactic reaction should carry self-injectable adrenaline

• Patients who have experienced an anaphylactic reaction should be referred to an allergist for study 16

Serum tryptase • Suspicion of anaphylaxis: monitoring 1. After treatment 2. 2 hours after onset 3. 24 hours

• Serum sample (empty vial or with coagulant) • Can be stored in fridge for processing next day

Adrenaline • Intramuscular administration is the choice for initial treatment in any setting (anterolateral aspect of thigh) • Dose (1mg = 1ml of adrenaline 1/1.000 aqueous solution) – Adults: 0,3 - 0,5 mg – Infants and children: 0,01 mg /kg, max. 0,3 mg • May be repeated at 5 -15 min depending on severity and tolerance


Discharge and follow-up • Observation 6-24 h • Detailed clinical report • Recomendations: selfinjectable adrenaline if indicated • Two adrenaline pens



Allergist referral • Preference • Diagnostic work-up • Patient education – Avoidance of culprit agent(s) – Anaphylaxis action plan: • Inform • Self-injectable adrenaline • Emergency telephone (112) or ER – Medical alert 21


Med Clin 2011;136:349-55


Future/ next steps • Invitation to participate Spanish GP´, Pediatrics and Anestheiologists Societies • Revision (2012) • Update edition (2013) • To study the implementation/impact assessment of the guideline • To perform local surveys • To evaluate: number of downloads and autoinjector prescriptions/habitant 25

Conclusions (1) • GALAXIA has been conducted in a record time. The collaboration of specialists with experience of different scientific societies facilitated the development of easy-to-read and understand guidelines, applicable in daily routine in both paediatric and adult patients.


Conclusions (2) • GALAXY is a useful tool for physicians involved in diagnosis and treatment of anaphylaxis. • The spread in different congresses, the publication and accessibility in different websites along with the recognition by the Spanish National Health System ensure its use. 27

Proyecto GALAXIA Gu铆a de Actuaci贸n en anafiLAXIA Agreements to Galaxia working group ALK-Abell贸 unrestricted grant

Take home message!

We have to be experts

Adapt guidelines



Tomás Chivato  
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