Anne Ellis, MD: Bettering Anaphylaxis Follow-Up

New findings reported this year showed the rate of anaphylaxes in US emergency settings have fallen in the last 10 years. But issues still persist in patient follow-up and outpatient response for cases that occur.

In an interview with MD Magazine® while at the American College of Allergy, Asthma & Immunology (ACAAI) 2019 Scientific Meeting in Houston, Anne Ellis, MD, professor and chair of the Division of Allergy & Immunology at Queen’s University, described what these findings mean for emergent allergy treatment response, and explained the role of an allergist in the first post-anaphylaxis follow-up.

MD Mag: What was discussed in your ACAAI session regarding anaphylaxis?

Ellis: I moderated 2 things today related to anaphylaxis. One was a session focusing on idiopathic anaphylaxis and people who have recurrent episodes of anaphylaxis for no good reason, and trying to distinguish when those patients truly have what we would actually call idiopathic—as in, we can't find a root cause—versus those patients who may have an underlying problem with their mast cells. That was the morning session.

Then, later in the morning, I focused on a literature review of the top 10 articles on anaphylaxis in the past year. The really common and emerging themes were that anaphylaxis in the emergency department has improved in the last decade, but still has gaps in terms of referring to allergists after an episode of anaphylaxis, prescribing people an epinephrine auto-injector upon discharge, and just making sure risk factors have been mitigated to their best potential.

MD Mag: Why is outpatient referral and follow-up worsened in anaphylaxis patients?

Ellis: It's really hard to ascertain why is it that certain centers in the United States have that same referral pathway to see an allergist after they've had an episode of anaphylaxis, compared to other centers that have been identified and clearly have good associations between the emergency department and the local allergists.

I think it's really just getting the awareness out for anybody who's in primary care, who's working in ED, to make sure if you are managing somebody with acute anaphylaxis, that the follow-up is almost as important as what you've done to stabilize them and make them safe while they're in the emergency department.

MD Mag: What should allergists be doing in initial follow-up with anaphylaxis patients?

Ellis: It behooves us as allergists to do a proper work-up—to figure out if we can identify an obvious culprit trigger for the episode. If not, and it appears there doesn't really seem to be a good explanation, we now have a good understanding of mast cell disorders, and we can look at things like a serum tryptase level. We can check for genetic mutations that identify these people as possibly having a problem with their mast cells that make them predisposed to have recurrent reactions.

So there's lots of tools in our toolbox we can use to evaluate patients who have had an episode of anaphylaxis, to either identify the trigger, to reduce the risk of future reactions, and we can better manage their comorbidities that put them at risk of recurrent episodes as well.

We can manage their asthma, we can manage their atopic dermatitis, we can make sure they are clearly aware of their food triggers, and how to properly read labels to minimize their chances of an unexplained or unexpected reaction.