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Supportive care of patients with anaphylaxis — options and shortcomings: an assessment on behalf of the working group on anaphylaxis training and education (AGATE), Germany

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Abstract

Background:

Anaphylaxis is an acute-onset, life-threatening, systemic hypersensitivity reaction. The acute reaction occurs due to a permanently immunologically altered response, which can result in mild to severe reactions and, in isolated cases, to fatal reactions upon allergen contact. The avoidance strategies required lifelong in affected individuals significantly impair quality of life.

Objective and methods:

An expert analysis of the supportive care situation of anaphylaxis patients.

Results:

The trigger of the reaction — mostly food, insect venom, or drugs — can normally be identified by means of allergy diagnostics. However, allergy workups unfortunately are not always performed in anaphylaxis patients. Unequivocal diagnosis and/or causal classification of the trigger is not always easy, particularly in the presence of summation factors, such as physical exertion or the use of analgesics or alcohol. Complex cases present too rarely in allergy centers with appropriate experience. Following anaphylaxis patients are given guidance on allergen avoidance and after obligatory instruction from a medical expert, receive a prescription for an emergency self-medication kit. However, studies show that allergen avoidance often fails and patient self-medication is frequently not performed. Therefore, the German working group on anaphylaxis training and education (Arbeitsgemeinschaft Anaphylaxie Training und Education, AGATE) formulated a structured written interdisciplinary educational training program that is currently used in 24 registered centers in Germany. In a multicenter study using control groups, the anaphylaxis training program showed significant efficacy in terms of practical emergency management and reduced anxiety. The nationwide implementation of the training program and cost-coverage by statutory health insurances appear reasonable given the potentially life-threatening nature of this disease. Since statutory health insurances have not guaranteed cost-coverage to date, it is not possible to offer the training program to all patients in need.

Conclusion:

Subject to region and center, there are good treatment options for anaphylaxis patients in Germany. However, these options are not always sufficiently implemented.

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Author information

Authors and Affiliations

  1. Department of Dermatology and Allergology am Biederstein, Technical University of Munich, Munich, Germany

    Knut Brockow, Tilo Biedermann, Claudia Kugler & Johannes Ring

  2. Department of Pediatric Pneumology and Immunology, Charité University Hospital, Berlin, Germany

    Kirsten Beyer & Norbert Gebert

  3. Department of Dermatology, Tübingen University Hospital, Tübingen, Germany

    Jörg Fischer

  4. Department of Dermatology and Allergology, Gießen and Marburg University Hospital (UKGM), Gießen site, Germany

    Uwe Gieler & Thilo Jakob

  5. Specialist Department for Children with Chronic Diseases, Gaisach Specialist Hospital, Gaisach, Germany

    Oliver Giessler-Fichtner

  6. Center for Rhinology and Allergology Wiesbaden, Department of Otorhinolaryngology, Head and Neck Surgery of the University Hospital Mannheim, Mannheim, Germany

    Ludger Klimek

  7. Nutrition Counseling in Allergies, Munich, Germany

    Imke Reese

  8. Pediatric Department, Cologne University Hospital, Cologne, Germany

    Ernst Rietschel

  9. Allergy Center, Department of Dermatology and Allergology, Munich University Hospital, Munich, Germany

    Franziska Ruëff

  10. German Allergy and Asthma Association (Deutscher Allergie und Asthmabund), Mönchengladbach, Germany

    Sabine Schnadt

  11. Bonn Patient Training (Patientenschulung Bonn e. V.), St.-Marien Hospital, Bonn, Germany

    Cäcilia Siemens & Lars Lange

  12. Osnabrück Children’s Hospital, Osnabrück, Germany

    Rüdiger Szczepanski

  13. Charité Allergy Center, Department of Dermatology, Venereology, and Allergology, Charité Campus Mitte, Berlin, Germany

    Margitta Worm

  14. Department of Dermatology and Allergology am Biederstein, Munich Technical University, Biedersteiner Straße 29, 80802, Munich, Germany

    Knut Brockow

Authors
  1. Knut Brockow
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  2. Kirsten Beyer
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  3. Tilo Biedermann
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  15. Cäcilia Siemens
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  16. Rüdiger Szczepanski
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  17. Margitta Worm
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  18. Johannes Ring
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  19. Lars Lange
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Consortia

the working group on anaphylaxis training and education (AGATE), Germany

Corresponding author

Correspondence to Knut Brockow.

Additional information

Conflict of interests

The authors Kirsten Beyer, Jorg Fischer, Uwe Gieler, Oliver Giessler-Fichtner, Norbert Gebert, Thilo Jakob, Claudia Kugler, Imke Reese, Franziska Rueff, Sabine Schnadt, Cacilia Siemens, Rudiger Szczepanski, Margitta Worm, Johannes Ring und Lars Lange state that there are no conflicts of interest. Knut Brockow has received fees for lectures or advisory activities for Phadia, Meda, ALK, and Novartis. Ludger Klimek has been working as a board member for Meda and Novartis; as a consultant for ALK-Abello, Allergopharma, Bionorica, Boehringer Ingelheim, GlaxoSmithKline, Lofarma, Novartis, and Meda, has received grants, payment for lectures including service on speakers bureaus and/or for manuscript preparation from ALK-Abello, Allergopharma, Bencard, Bionorica, Biomay, HAL, Boehringer Ingelheim, GlaxoSmithKline, Leti, Lofarma, Meda, Novartis, and Roxall. Ernst Rietschel has been working as an advisory board member for Meda and Bauch + Lomb.

Cite this as

Brockow K, Beyer K, Biedermann T, Fischer J, Gieler U, Giessler-Fichtner O, Gebert N, Jakob T, Klimek L, Kugler C, Reese I, Rietschel E, Ruëff F, Schnadt S, Siemens C, Szczepanski R, Worm M, Ring J, Lange L. Supportive care of patients with anaphylaxis — options and shortcomings: an assessment on behalf of the working group on anaphylaxis training and education (AGATE), Germany. Allergo J Int 2016;25:160–8 DOI: 10.1007/s40629-016-0123-3

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Brockow, K., Beyer, K., Biedermann, T. et al. Supportive care of patients with anaphylaxis — options and shortcomings: an assessment on behalf of the working group on anaphylaxis training and education (AGATE), Germany. Allergo J Int 25, 160–168 (2016). https://doi.org/10.1007/s40629-016-0128-y

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  • DOI: https://doi.org/10.1007/s40629-016-0128-y

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