Home Monitoring or ER? Updated Anaphylaxis Recommendations



Have you heard about the new anaphylaxis management algorithm?

If you or someone you love has had anaphylaxis that required an epi-pen, it is likely that you were told to call 911 and immediately go to the ER for observation.

Last week, FARE updated their recommendations to include COVID-19 into the risk/benefit balance of monitoring at home vs. an ER visit. This is especially important in areas where ERs are swamped with COVID-19 patients although most ERs have new procedures to screen for COVID-19 when getting checked in along with a focus on minimized time spent with any patient to lessen risk of transmission. 

As you can imagine, these new recommendations have caused a bit of controversy and concern in the food allergy and mast cell disease world.

Let’s take a closer look at the new recommendations and why they are being made.

Dr. Thomas B. Casale, the chief medical advisor for operations with FARE (Food Allery Research & Education)  and professor of medicine and pediatrics at the University of South Florida, published a paper in The Journal of Allergy and Clinical Immunology: In Practice, “Acute At Home Management Of Anaphylaxis During The COVID-19 Pandemic.”  

As quoted in  FARE Chief Medical Advisor Publishes New Guidance to Treat Patients Experiencing Anaphylaxis Amid COVID-19 Spread:

“Emergency departments are overwhelmed by the COVID-19 crisis and an anaphylactic event is very serious, but at-home care is possible in many situations so long as extra precautions are taken on behalf of both patients and caregivers,” said Dr. Casale. “It is our hope that in pivoting where possible we can protect food allergy patients nationwide while simultaneously slowing the spread of this virus.”

To be clear, the paper and recommendations were written for allergists, immunologists, and other doctors who care for patients with anaphylaxis.

So, do not make changes without checking in with your doctor to discuss and determine if your emergency protocol needs to be updated. 


Revised Anaphylaxis Management Algorithm During COVID Pandemic


Click here for a PDF version of this algorithm.

What to Do Now
  • Contact your Doctor and discuss your emergency protocol including when you should monitor at home vs go to ER.
  • Get a new anaphylaxis management plan in writing that you can use in the ER
  • Determine which ER you should go to
  • Make sure you have adequate epi-pens, rescue meds and prescription refills, in case you need to use them and require refills.
  • Discuss your protocol with your family and friends, especially changes to your protocol and areas that you may need them to advocate or communicate for you.

During Anaphylaxis
  • Follow your updated emergency protocol that you have discussed with your doctor.
  • Administer your epi-pen as directed
  • Monitor and follow directions on protocol
  • Contact your physician
  • Refill your epi-pens and rescue meds if necessary

Anaphylaxis Requiring ER
  • Go to recommended ER (there may be designated non-COVID-19 ERs)
  • Bring your ER protocol letter with you to ER
  • Bring your epi-pens and/or rescue medications in original packaging
  • Bring safe food with you in case you are kept for observation
  • Make your medical history and information as simple to understand as possible
  • Be aware that in most ERs no visitors or additional people are allowed.

I know these changes are new and feel unsettling so turn to your doctor to help you find the right solution for you.   Stay safe!


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