Anaphylaxis Logogram: decision tools to facilitate the diagnosis and management of anaphylaxis in primary care

AIM: Most cases of anaphylaxis are first seen by general practitioners (GPs) and emergency doctors, but its recognition and management are still challenging in clinical practice. The European Academy of Allergy and Clinical Immunology (EAACI) task force in primary care proposed a construction of a logogram focused on anaphylaxis to harmonise integrated health care pathways improving the quality management of these patients.METHODS: First, a systematic review (SR) on anaphylaxis in primary care was performed and the specific findings were the basis of the construction of a main schematic decision tree addressed to both adults and children. The resulting anaphylaxis logogram was based on a pragmatic primary care interpretation of the SR outcomes in the main anaphylaxis etiologies (food, drugs and Hymenoptera allergies). Its definitive form has been decided by the whole Task Force group including GPs, allergy specialists, researchers and clinical fellows around interdisciplinary discussions.RESULTS: The anaphylaxis logogram includes 4 decision trees, which layers will be electronically linked: a core logogram with general diagnosis and management of anaphylaxis in adults and paediatric population; three other frameworks are focused on the main aetiologies. For each, the logograms have been built up to cover 2 situations: (1) acute phase of anaphylaxis and, (2) personal history suggestive of anaphylaxis. This algorithm guides GPs to three main steps: a) diagnose anaphylaxis precisely, b) appropriate, immediate first line treatment and management, c) recommendations for patient referral for specialist assessment and specific recommendations (patient’s education) to avoid recurrences. Two background layers have been built in order to provide more detailed information for GPs, such as terminologies, red flag signs, severity score scoring, potential differential diagnosis.CONCLUSION: We here present a decision tree focused on anaphylaxis to support GPs in the recognition and management of patients with anaphylaxis. Further steps include undergoing electronic adaptation and field-testing for validation of these logograms. All these findings have the unique goal of optimising integrated health care pathways, patient experience and prevent avoidable deaths. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest NO CONFLICT OF INTEREST. References and Clinical Trial Registry Information