COVID-19 Resource Center
COVID-19 Resource Center
April 29, 2020
2 min read

Q&A: Algorithm provides at-home anaphylaxis treatment instructions during COVID-19 pandemic

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Thomas Casale
Thomas B. Casale

Researchers have developed an at-home anaphylaxis management algorithm for patients who need emergency epinephrine treatment. Importantly, it may prevent unnecessary ED visits — a particularly helpful development given the risk that COVID-19 poses in health care settings.

“There is a tremendous, and understandable, reluctance to visit emergency departments right now,” Thomas B. Casale, MD, a professor of medicine and pediatrics and chief of clinical and translational research at the University of South Florida, told Healio Primary Care. “Patients are potentially putting themselves at an increased risk for contracting COVID-19 by leaving their homes and going to the hospital.”

Casale spoke with Healio Primary Care about the new algorithm, how it works, and who would benefit most from its use. – by Janel Miller

Q: Can you describe the algorithm?

Emergency Room Sigh 
The "tremendous, and understandable, reluctance to visit emergency departments right now," prompted Thomas B. Casale, MD, and others to develop an algorithm that provides at-home anaphylaxis treatment instructions during COVID-19 pandemic.
Source:Adobe Stock

A: The new algorithm instructs patients to inject epinephrine at the first sign of anaphylaxis (such experiencing hives on their skin, significant swelling of their lips and/or has shortness of breath). This should be done while seated and with a telephone within reach. From there, patients should notify a housemate, neighbor or anyone else nearby to help them. They should lie down with their legs elevated near an unlocked or open doorway so others can come in and out, including emergency care professionals if needed. Next, patients should administer an oral antihistamine and albuterol, if prescribed and available. Patients and whoever they have helping them should then monitor the patients’ symptoms and blood pressure/pulse, if possible. Though there could be variations to patients’ BP levels based on their “normal” BP, in most instances, if a patient’s BP falls below 90 mm Hg and if their diastolic BP falls below 60 mm Hg, call a doctor.

If symptoms resolve at home, patients should monitor for any recurrence for 4 to 6 hours. If symptoms reappear, it’s important that patients and their helpers are ready to administer treatment once again. It is also recommended that patients contact their physician on a nonurgent basis and replenish their emergency medications as soon as possible. If symptoms do not improve or they worsen, patients should inject epinephrine a second time. If symptoms still don’t improve or worsen, then after the second dose, emergency services — such as calling 911 — should be activated.

Q: Can you provide a quick step-by-step review on autoinjector use?

A: There are different step-by-step instructions depending on the type of autoinjector a patient has. However, for most autoinjectors, patients will need to remove it from packaging, remove any safety caps and firmly place the end of the autoinjector into the side of the thigh, injecting the medication. Patients will then remove the autoinjector after between 2 and 10 seconds, place it back into its safety case and properly dispose of it.

Q: Who will benefit from the new algorithm most?

A: This revised algorithm and guidance is directed toward allergists, immunologists and other physicians who provide care to food allergy patients. We encourage all food allergy patients to have discussions with their allergists to see if this new algorithm is right for them and to iron out the details about their own personal COVID-19 emergency care plan. Geographical considerations and other factors, like a person’s history with anaphylaxis, will certainly come into play when making a final decision.


Casale TB, et al. J Allergy Clin Immunol Pract. 2020;doi: 10.1016/j.jaip.2020.04.022.

Disclosures: Casale is chief medical advisor for operations at Food Allergy Research and Education, or FARE. He also reports receiving research support from Aimmune and Regeneron. Please see the editorial for all other authors’ relevant financial disclosures.