Michael and his buddies laughed and joked, enjoying their reunion at the oceanside cafe. But as he ate, Michael began to feel his mouth tingle.

Michael drank some water, but within minutes he felt lightheaded and noticed a rash forming on his arms. He knew he needed medical help. His buddies drove him to the hospital emergency department, a few miles away. By the time he arrived, he was feeling dizzy and short of breath.

The ED medical team recognized his symptoms and treated him with epinephrine, the recommended treatment for the severe allergic reaction called anaphylaxis.

Michael's symptoms gradually subsided. The doctor explained he had probably experienced an allergic reaction. He gave Michael a prescription for self-injectable epinephrine (EpiPen®) and a referral to an allergist for follow-up.

This story could have had a different ending. An allergic reaction to food can range from an itchy mouth or mild stomach discomfort to life-threatening respiratory problems and anaphylactic shock.

Anaphylaxis treatment guidelines issued by the American Academy of Allergy, Asthma and Immunology (AAAAI) recommend that physicians

• Administer epinephrine to treat severe allergic reactions
• Teach patients proper techniques for self-administration of epinephrine
• Refer patients to an allergist

However, a recent study published in the Journal of Allergy and Clinical Immunology (Feb. 2004) found emergency department personnel do not always follow these guidelines. Reviewing records of 678 ED food allergy patients, researchers found only 16 percent were treated with epinephrine; 16 percent were sent home with a prescription for epinephrine; and 12 percent were referred to an allergist.

"Patients need to learn more about their allergies, because they can be fatal," says researcher Carlos Camargo, MD, DrPH, director, EMNet Coordinating Center, Massachusetts General Hospital in Boston and medical editor of Allergy & Asthma Today. "Those who have severe allergic reactions should carry self-injectable epinephrine and learn how to use it."

Dr. Camargo believes that a major problem with anaphylaxis guidelines is that the definition of anaphylaxis remains somewhat controversial. Also, he points out that the development of AAAAI guidelines did not include the participation of emergency physicians or other health professionals who are expected, nevertheless, to use the guidelines in the course of their clinical care. He is working closely with the AAAAI and other organizations to address both of these issues and thereby improve anaphylaxis diagnosis and treatment in the emergency department.