The treatment of acute anaphylaxis does not end with the acute episode. The cause of the reaction should be determined when possible. History is of vital importance. Cutaneous testing and radio-immunoassays for specific IgE should be carried out. The findings should be clearly documented and explained to the patient, who should be instructed to carry a letter and/or a Med-Alert tag at all times. Patients at risk from secondary exposure, particularly when exposure is inadvertent, should be instructed in self-medication or parent medication with injectable or inhaled epinephrine. Patients with recurrent anaphylaxis where a cause cannot be found should be treated with steroids on alternate days. Desensitization should be considered where possible, and pretreatment with antihistamines, sympathomimetics, and steroids may be effective in preventing secondary reactions under some circumstances such as reactions to intravenous contrast media (Ljeberman.1990.).

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