Announcements: The interactive Clinical Pathways (https://clinicalpathways.ebmedicine.net/) have launched and they are available for free! — In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2022 Emergency Medicine Practice article on the Management of Allergic Reactions and Anaphylaxis in the Emergency Department (https://www.ebmedicine.net/topics/allergic-immunologic-inflammatory/emergency-medicine-allergy-anaphylaxis).  Intro* The number of ED visits and hospitalizations* Studies show up to 57% of anaphylactic reactions are not recognized, and epinephrine is not administered in up to 80% of cases. Criteria* 2006 Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network (NIAID/FAAN)* WAO revised the criteria in 2020 * Delphi group and Brown et alPathophysiology Epidemiology* Most common causes in children and adults* More than half of deaths from anaphylaxis occur within the first hour of symptom onsetPrehospital Care* Give epi, H1 blockers* Mainstay = recognitionED Care* Airway* Epinephrine* Decontamination* H1 and H2 blockers* Corticosteroids* Biphasic reactions* GlucagonSpecial Cases* Alpha-gal* Scombroid* Kounis syndrome