Table 3 Preventive Measures to Reduce the Risk of Anaphylaxis

   Obtain a thorough history to diagnose life-threatening food or drug allergy

   Identify cause of anaphylaxis and those individuals at risk of future attacks

   Provide instruction on proper reading of food and medication labels, where appropriate

   Avoidance of exposure to antigens and cross-reactive substances

   Optimal management of asthma and coronary artery disease

   Implement a waiting period of 20 to 30 min after injections of drugs or other biologic agents

   Consider a waiting period of 2 h if a patient receives an oral medication in the office he/she has never previously taken

Specific measures for high-risk patients

   Individuals at high risk of anaphylaxis should carry self-injectable syringes of epinephrine at all times and receive instruction in proper use with a placebo trainer

   MedicAlert or similar warning bracelets or chains

   Substitute other agents for β-adrenergic antagonists, angiotensin-converting enzyme inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, and certain tricyclic antidepressants whenever possible

   Slow, supervised administration of agents suspected of causing anaphylaxis, orally if possible

   Where appropriate, use specific preventive strategies, including pharmacologic prophylaxis, short-term challenge and desensitization, and long-term desensitization