Circular No. 51/2017/TT-BYT on guiding the prevention, diagnosis, and management of anaphylaxis

 CIRCULAR

Guidelines for Preventing, Diagnosing, and Treating Anaphylaxis

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Pursuant to the Law on Medical Examination and Treatment 2009;

Pursuant to the Government's Decree No. 75/2017/NĐ-CP dated June 20, 2017 stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director of the Department of Medical Examination and Treatment,

The Minister of Health issues the Circular on Guidelines for Preventing, Diagnosing, and Treating Anaphylaxis.June 2024;1. This Circular provides guidelines for preventing, diagnosing, and treating anaphylaxis.

Article 1. Scope of Regulation and Applicability

2. This Circular applies to medical examination and treatment facilities, medical practitioners, and related organizations and individuals.

Anaphylaxis

Article 2. Interpretation of Terms

1. is an allergic reaction that may occur immediately from a few seconds to several hours after exposure to an allergen, causing various clinical symptoms that can be severe enough to lead to rapid death. Allergen

2. is a foreign substance capable of triggering an allergic reaction upon contact with the body, including food, medication, and other factors. Anaphylactic Shock

3. is the most severe form of anaphylaxis caused by sudden dilation of the entire vascular system and bronchospasm, which can result in death within minutes. Article 3. This Circular annexes the following guidelines for preventing, diagnosing, and treating anaphylaxis:

1. Guidelines for diagnosing anaphylaxis at Appendix I.

2. Guidelines for assessing the severity of anaphylaxis at Appendix II.

3. Guidelines for emergency treatment of anaphylaxis at Appendix III.

4. Guidelines for treating anaphylaxis in certain special cases at Appendix IV.

5. Emergency kit and medical equipment for anaphylaxis at Appendix V.

6. Guidelines for collecting allergy history at Appendix VI.

7. Sample allergy tracking card at Appendix VII.

8. Guidelines for skin testing at Appendix VIII.

9. Technical procedures for skin testing at Appendix IX.

10. Diagnostic and treatment flowchart for anaphylaxis at Appendix X.

Article 4. Principles of Anaphylaxis Prevention

Medical examination and treatment facilities, doctors, and healthcare staff must ensure adherence to the following principles of anaphylaxis prevention:

1. Prescribe the most appropriate route of administration for medications, and administer by injection only when other routes are not feasible.

2. Do not conduct allergy tests for all medications unless specifically indicated by a doctor according to the guidelines set forth in Appendix VIII of this Circular.

3. Do not prescribe or administer medications or allergens known to cause anaphylaxis to patients.

In cases where there is no suitable alternative medication or allergen and it is necessary to use a medication or allergen previously causing anaphylaxis, a consultation with an allergy-immunology specialist or a doctor trained in anaphylaxis prevention, diagnosis, and treatment must be conducted to reach a consensus, and such decision must be documented in writing with the patient's or their legal representative's consent.

Conducting an allergy test on a patient with a known allergen must be performed by an allergy-immunology specialist or a doctor trained in anaphylaxis prevention, diagnosis, and treatment.

4. All cases of anaphylaxis must be reported to the National Center for Drug Information and Adverse Drug Reaction Monitoring or the Ho Chi Minh City Center for Drug Information and Adverse Drug Reaction Monitoring using the current adverse drug reaction reporting form as stipulated in Appendix V of Circular No. 22/2011/TT-BYT dated June 10, 2011, issued by the Minister of Health regarding the organization and operation of hospital pharmacy departments.

5. Doctors, prescribers, or other authorized healthcare personnel must thoroughly investigate the patient's history of drug and allergen allergies before prescribing medication or administering drugs according to the guidelines set forth in Appendix VI of this Circular. All information related to allergies and allergens must be recorded in the medical record, discharge summary, and transfer certificate.

6. Once the causative drug or allergen has been identified, doctors and healthcare staff must provide the patient with an allergy tracking card clearly stating the name of the drug or allergen causing the allergy according to the guidelines set forth in Appendix VII of this Circular, explain in detail, and remind the patient to provide this information to doctors and healthcare staff during each medical examination or treatment session.

6. When the drug or allergen causing anaphylaxis has been identified, the doctor or healthcare staff must provide the patient with an allergy monitoring card clearly stating the name of the drug or allergen causing the allergic reaction according to the guidelines set out in Appendix VII attached to this Circular, and thoroughly explain and remind the patient to provide this information to doctors or healthcare staff each time they seek medical treatment.

Article 5. Preparation and Prevention for Anaphylactic Emergency

1. Adrenaline is the essential and top priority drug readily available for immediate treatment of anaphylaxis.

2. At places where medication is used, injection vehicles must be equipped and ready with an anaphylaxis emergency kit. The components of the anaphylaxis emergency kit are specified in Section I of Appendix V attached to this Circular.

3. Medical examination and treatment facilities must have an anaphylaxis emergency kit and medical equipment as prescribed in Section II of Appendix V attached to this Circular.

4. Doctors and healthcare staff must be well-versed in knowledge and practice of anaphylaxis emergency treatment according to the protocol.

5. On public transportation means such as airplanes, ships, trains, anaphylaxis emergency kits must be equipped according to the guidelines set out in Section I of Appendix V attached to this Circular.

Article 6. Management of Anaphylaxis

1. Adrenaline is the top priority drug for intramuscular injection immediately upon diagnosis of anaphylaxis at level II or higher.

2. Doctors, medical officers, nurses, midwives, technicians must manage anaphylaxis emergency treatment according to the guidelines set out in Appendices III and IV attached to this Circular.

3. For individuals with a history of anaphylaxis who carry adrenaline, patients or others who are not healthcare personnel may be permitted to use the medication in emergencies for intramuscular injection when there is no healthcare personnel present.

Article 7. Effective Date

1. This Circular takes effect from February 15, 2018.

2. Circular No. 08/1999/TT-BYT dated May 4, 1999 of the Minister of Health on guidelines for prevention and emergency treatment of anaphylactic shock becomes invalid from the date this Circular comes into force.

Article 8. Reference Provisions

In cases where laws and regulations cited in this Circular are amended, supplemented, or replaced, they shall be applied according to the new laws and regulations.

Article 9. Responsibility for implementation

1. Responsibilities of heads and professionals in charge of medical examination and treatment facilities:

a) Strictly implement this Circular at medical examination and treatment facilities.

b) Issue specific guidelines, rules, and procedures for application at medical examination and treatment facilities based on the guidance of this Circular.

c) Train, instruct, and disseminate this Circular to practitioners and healthcare personnel under their management at medical examination and treatment facilities.

2. The Director of the Department of Medical Examination and Treatment is responsible for organizing implementation, inspection, and evaluation of this Circular.

3. The Heads of the Office of the Ministry, the Inspectorate of the Ministry, the General Directors, the Department Heads, the Bureau Chiefs, the Ministry of Health, the Health Departments of provinces and centrally-administered cities, the heads of health departments of ministries, sectors, organizations, and individuals related to this matter are responsible for implementing this Circular.

During implementation, if difficulties arise, units and localities are requested to promptly report to the Department of Medical Examination and Treatment, Ministry of Health for guidance, review, and resolution.

 

 

ANNEX I

GUIDELINES FOR DIAGNOSIS OF ANAPHYLAXIS
(Issued together with Circular No. 51/2017/TT-BYT dated December 29, 2017 of the Minister of Health)

I. Diagnosis of Anaphylaxis:

1. SymptomsnationalNote

Consider anaphylaxis when at least one of the following symptoms appears:

a) Urticaria, angioedema.

b) Difficulty breathing, chest tightness, wheezing.

c) Abdominal pain or vomiting.

d) Hypotension or fainting.

e) Altered consciousness.

2. Clinical scenarios:

1. Clinical scenario 1: Symptoms appear within seconds to hours in the skin and mucous membranes (urticaria, angioedema, itching...) and at least one of the following two symptoms:

a) Respiratory symptoms (difficulty breathing, wheezing, stridor).

b) Hypotension or consequences of hypotension (altered consciousness, incontinence of bowel/bladder...).

2. Clinical scenario 2: At least two of the following four symptoms appear within seconds to hours after exposure to suspected factors:

a) Skin and mucosal manifestations: urticaria, angioedema, itching.

b) Respiratory symptoms (difficulty breathing, wheezing, stridor).

c) Hypotension or consequences of hypotension (altered consciousness, incontinence of bowel/bladder...).

d) Gastrointestinal symptoms (vomiting, abdominal pain...).

3. Clinical scenario 3: Hypotension appears within seconds to hours after exposure to suspected factors that the patient has previously been allergic to:

a) Children: decrease in systolic blood pressure (maximum blood pressure) by at least 30% or systolic blood pressure drop compared to age (systolic blood pressure < 70 mmHg).

b) Adults: Systolic blood pressure < 90 mmHg or a 30% reduction in baseline systolic blood pressure.

II. Differential Diagnosis:

1. Shock cases: cardiogenic shock, hypovolemic shock, septic shock.

2. Cerebrovascular accidents.

3. Respiratory causes: COPD, asthma attack, upper airway obstruction (due to foreign body, inflammation).

4. Other diseases causing: For coal-fired thermal power plants where the enterprise holds 100% of the registered capital and uses 100% of its own capital to invest in the project approved by the competent authority, E is determined as 100%;a: urticaria, angioedema.

5. Endocrine disorders: thyrotoxic storm, carcinoid syndrome, hypoglycemia.

6. Poisonings: alcohol, opiates, histamine./.

 

ANNEX II

GUIDELINES FOR GRADING OF ANAPHYLAXIS
(Issued together with Circular No. 51/2017/TT-BYT dated December 29, 2017 of the Minister of Health)

Anaphylaxis is classified into four levels as follows:

(Note: the severity of anaphylaxis can escalate very quickly and does not follow a sequential pattern)priority intention 1. Mild (Level I)

: Only cutaneous, subcutaneous, and mucosal symptoms such as urticaria, itching, angioedema.2. Moderate (Level II)

: Two or more organ systems involved:a) Rapid onset of urticaria, angioedema.

b) Rapid shallow breathing, chest tightness, hoarseness, runny nose.

c) Abdominal pain, vomiting, diarrhea.

d) Blood pressure not yet decreased or increased, rapid or irregular heart rate.

3. Severe (Level III)

: More severe involvement of multiple organ systems as follows:a) Airway: stridor, laryngeal edema.

b) Breathing: rapid breathing, wheezing, cyanosis, respiratory rhythm disturbance.

c) Consciousness disturbance: agitation, coma, convulsions, autonomic dysfunction.in.

d) Circulation: shock, rapid weak pulse, hypotension.

4. Cardiac Arrest (Level IV)

: Manifestation of respiratory arrest, circulatory arrest./.GUIDELINES FOR EMERGENCY MANAGEMENT OF ANAPHYLAXIS

 

ANNEX III

(Issued together with Circular No. 51/2017/TT-BYT
dated December 29 2017June 2024;1. All cases of anaphylaxis must be detected early, treated urgently, and continuously monitored for at least 24 hours. of the Minister of Health)

I. General Principles

2. Doctors, nurses, midwives, technicians, and other healthcare personnel must provide initial emergency treatment for anaphylaxis.ỗ Adrenaline is the essential and top priority life-saving drug for anaphylaxis patients,of the Government stipulating functions, tasks, powers, and organizational structure of the Ministry of Home Affairsand must be administered intramuscularly immediately upon diagnosis of anaphylaxis at Level II or higher.

4. In addition to these guidelines, special cases must also be managed according to the guidelines set out in Appendix IV attached to this Circular.

3. II. Management of Mild Anaphylaxis must be administered immediately upon diagnosis of anaphylaxis at level II or higher.ắp.

4. In addition to these guidelines, for certain special cases, treatment must also follow the guidelines set out in Appendix IV attached to this Circular.

II. Management of mild anaphylaxis (Degree I): Allergic reaction but may become severe or critical

1. Administer methylprednisolone or diphenhydramine orally or by injection depending on the patient's condition.

2. Continue monitoring for at least 24 hours to handle promptly.

III. Protocol for emergency treatment of severe and critical anaphylactic reactions (Degree II,councillORSI) IIAnaphylaxis Degree II can rapidly progress to Degree III, Degree IV. Therefore, urgent and simultaneous treatment must be provided according to the disease progression:

1. Immediately stop contact with the drug or allergen (if present).

2. Administer adrenaline injection or infusion (as detailed in Section IV below).

3. Have the patient lie down in place, head low, tilted left if vomiting occurs.

4. Oxygen: adults 6-10 liters/minute, children 2-4 liters/minute through a mask

5. Assess respiratory status, circulation, consciousness, and skin and mucous membrane manifestations of the patient.in a) Perform external chest compressions and use a bag valve mask (if respiration and circulation have stopped).in.

b) Insert endotracheal tube or perform emergency tracheotomy (if there is difficulty breathing).

6. Establish intravenous adrenaline route with a standard drip set but with a larger needle (14 or 16G) or place a catheter and a second intravenous line for rapid fluid administration (as detailed in Section IV below).

7. Consult with colleagues, concentrate on handling, report to superiors, consult with emergency specialists, intensive care specialists, and/or allergy specialists (if available).

IV. Protocol for Adrenaline Administration and Fluid Infusion rock Objective: Maintain systolic blood pressure of adults ≥ 90mmHg, children ≥ 70mmHg, and eliminate respiratory symptoms such as wheezing, difficulty breathing, digestive symptoms such as vomiting, diarrhea.

1. Adrenaline dose:ồmg =policiesml = 1 vial, administered intramuscularly:

a) Newborns or infants < 10kg: 0.2ml (equivalent to 1/5 vial).

b) Infants around 10kg: 0.25ml (equivalent to 1/4 vial).inc) Children around 20kg: 0.3ml (equivalent to 1/3 vial).of the Government stipulating functions, tasks, powers, and organizational structure of the Ministry of Home Affairsd) Children > 30kg: 0.5ml (equivalent to 1/2 vial).

e) Adults: 0.5-1ml (equivalent to 1/2-1 vial). 12. Monitor blood pressure every 3-5 minutes. 13. Repeat adrenaline injection at the dose specified in Clause 1 of Section IV every 3-5 minutes until blood pressure and pulse stabilize.

4. If pulse cannot be detected and blood pressure cannot be measured, respiratory and digestive symptoms worsen after 2-3 intramuscular injections as specified in Clause 1 of Section IV, or there is a risk of circulatory arrest, then:

a) If no intravenous access has been established: Slow intravenous injection of diluted adrenaline solution 1/10,000 (1 vial of adrenaline

mg mixed with 9ml of distilled water = diluted 1/10). The dose of adrenaline for slow intravenous injection during anaphylactic shock is only 1/10 of the dose for intravenous injection during cardiac arrest. Dose:

Adults: 0.5-1ml (diluted 1/10,000 = 50-100 No.4/ For expenditures from the central budget under program-targets of the science, technology, and environment sector (if any), the Ministry of Science and Technology and Environment will coordinate with the Ministry of Finance and the State Planning Commission to allocate these funds to each ministry, central agency, and province right from the beginning of the year. The Ministry of Finance will directly disburse funds to ministries, central agencies, and authorize through provincial finance departments according to approved amounts and final accounts as per Circular No. 80/TC-NSNN dated September 24, 1993 of the Ministry of Finance.

µg) injected over 1-3 minutes, a second or third injection can be given after 3 minutes if pulse and blood pressure have not stabilized. Switch immediately to continuous intravenous infusion once the line is established.

Children:

Slow intravenous injection is not applicable.

b) If intravenous access is already established, administer continuous intravenous adrenaline infusion (mix adrenaline with 0.9% sodium chloride solution) for patients who poorly respond to intramuscular adrenaline and have received adequate fluids. Start with a dose of 0.1ầg/kg/minute, adjust the adrenaline dose every 3-5 minutes based on the patient's response.

c) Simultaneously with continuous intravenous adrenaline infusion, administer a rapid infusion of 0.9% sodium chloride solution 1,000ml-2,000ml in adults, 10-20ml/kg in 10-20 minutes in children, which can be repeated if necessary.policies5. Once stable blood pressure is maintained via continuous intravenous adrenaline infusion, monitor pulse and blood pressure every hour for up to 24 hours. 1Reference table for diluting adrenaline with 0.9% NaCl solution and slow intravenous infusion rateon1 vial of adrenalineonmg mixed with 250ml of 0.9% NaCl solution (thus,

- ml of diluted solution contains 4ớd g of adrenaline)Patient weight (kg)Initial intravenous adrenaline infusion dose (0,

- 1µ g/kg/minute)

Infusion rate (drops/minute) with 1ml syringe = 20 drops Patient weight (kg)Approximately 80

2ml

40 drops

Approximately 70

,75ml 135 drops 1Approximately 60Patient weight (kg),50ml

2. If blood pressure cannot be stabilized according to the target after adequate fluid and adrenaline administration, additional colloid solutions (such as plasma, albumin, or any available high molecular weight solution) may be infused.

3. Other drugs:

- Methylprednisolonein 2mg/kg for adults, maximum 50mg for children or hydrocortisone 200mg for adults, maximum4. Enterprises have the right to choose electronic energy labels for equipment and devices suitable for electronic energy labeling or to use other types of energy labels to implement energy labeling.mg for children, administered intravenously (can be administered intramuscularly in remote settings).4. Enterprises have the right to choose electronic energy labels for equipment and devices suitable for electronic energy labeling or to use other types of energy labels to implement energy labeling.- Antihistamines H1 such as diphenhydramine administered intramuscularly or intravenously: 25-50mg for adults, 10-25mg for children.

- Antihistamines H2 such as ranitidine: 50mg for adults,

mg/kg in 20ml of 5% Dextrose intravenously over 5 minutes for children.

- Glucagon: used in cases of hypotension and bradycardia unresponsive to adrenaline. Dose: 0.5-5mg intravenously over 5 minutes for adults, 20-30

g/kg, maximum 1mg for children, followed by continuous intravenous infusion at 5-15 Patient weight (kg)g/minute based on clinical response. Ensure airway patency because glucagon often causes vomiting. Patient weight (kg)- Additional vasopressor drugs such as dopamine, dobutamine, or norepinephrine may be administered intravenously when the patient is in severe shock, has received adequate fluids and adrenaline, but blood pressure remains low.oVI. Monitoring

1. During the acute phase: monitor pulse, blood pressure, respiratory rate, SpO2, and consciousness every 3-5 minutes until stabilization. 2. During the stable phase: monitor pulse, blood pressure, respiratory rate, SpO2, and consciousness every 1-2 hours for at least 24 hours.3. All anaphylaxis patients need to be monitored in a medical facility for at least 24 hours after blood pressure has stabilized and the second phase of anaphylaxis prevention.ầ4. Terminate emergency care: if active resuscitation efforts after cardiac arrest are unsuccessful./.4. Enterprises have the right to choose electronic energy labels for equipment and devices suitable for electronic energy labeling or to use other types of energy labels to implement energy labeling.lần, 4-6 times daily.

2. If notg n.g able to achieve blood pressure targets after adequate fluid resuscitation and adrenaline administration, additional colloid solutions (such as plasma, albumin, or any available high molecular weight solution) should be administered.development truyonn additional colloid solutions (such as plasma, albumin, or any available high molecular weight solution).

3. Other medications:

- Methylprednisolone 1-2mg/kg for adults, maximum 50mg for children or hydrocortisone 200mg for adults, maximum 100mg for children, intravenous injection (intramuscular injection may be used if necessary).

- Antihistamine H1 such as diphenhydramine intramuscular or intravenous: 25-50mg for adults and 10-25mg for children.

- Antihistamine H2 such as ranitidine: 50mg for adults, for children 1mg/kg diluted in 20ml of 5% Dextrose intravenously over 5 minutes.

- Glucagon: used in cases of hypotension and bradycardia unresponsive to adrenaline. Dosage: 5-10 1mg intravenously over 5 minutes for adults, 20-30g g/kg for children, maximumPatient weight (kg)mg, followed by continuous intravenous infusion at 5-15 1g/min depending on clinical response. Ensure airway protectionPatient weight (kg)t because glucagon often causes vomiting.No.- Additional vasopressors can be combined: dopamine, dobutamine, noradrenaline intravenous infusion when the patient is in severe shock despite adequate fluid resuscitation and adrenaline, but blood pressure does not improve.

VI. Monitoring

1. During the acute phase: monitor pulse, blood pressure, respiratory rate, SpO

and consciousness every 3-5 minutes until stable.O₂ 2. During the stabilization phase: monitor pulse, blood pressure, respiratory rate, SpO4. Enterprises have the right to choose electronic energy labels for equipment and devices suitable for electronic energy labeling or to use other types of energy labels to implement energy labeling.and consciousness every 1-2 hours for at least the next 24 hours.

3. All patients with anaphylaxis need to be monitored at a medical facility for at least 24 hours after blood pressure has stabilized and to prevent phase 2 anaphylaxis.O₂ 4. Termination of emergency care: if active resuscitation efforts cease without result after emergency care.

ng beta-blockers:of the Government stipulating functions, tasks, powers, and organizational structure of the Ministry of Home Affairs2. Anaphylaxis during anesthesia induction,policiesanesthesia maintenance, presenting any of the following symptoms:on • Mouth, throat: Itching, lip swelling, tongue swelling, difficulty breathing, hoarseness.

• Skin: Itching, rash, redness, swelling.

 

ANNEX IV

GUIDELINES FOR HANDLING ANAPHYLAXIS IN CERTAIN SPECIAL CASES
(Issued together with Circular No. 51/2017/TT-BYT dated December 29, 2017 of the Minister of Health)

I. Anaphylaxis on Individuals Using Special Medications

1. Anaphylaxis on Individuals Using Beta Blockersurinary catheter• Digestive system: Nausea, diarrhea, abdominal pain.development • Respiratory system: Difficulty breathing, chest tightness, wheezing, cough.

a) The patient's response to adrenaline is often poor, increasing the risk of death.đổ b) Treatment: generally similar to the general protocol for handling anaphylaxis, with close monitoring of blood pressure, intravenous adrenaline administration, and possibly additional vasopressor medications.

c) Bronchodilators: if beta-2 agonists are ineffective, anticholinergics such as ipratropium (0.5mg inhalation or two sprays) should be considered.

d) Consider using glucagon when there is no response to adrenaline.

2. Anaphylaxis During Anesthesia or Surgery

• Cardiovascular system: Weak pulse, dizziness.ê2) Always carry adrenaline with you.ê a) These cases are often difficult to diagnose because the patient has been anesthetized, sedated, and skin manifestations may not appear, making subjective signs unassessable. Careful evaluation of symptoms during anesthesia or surgery, such as hypotension, decreased oxygen saturation, rapid pulse, changes on monitoring equipment, and new wheezing, is necessary.

b) When anaphylaxis is suspected, blood can be taken at the time of diagnosis to measure tryptase levels and the patient's baseline tryptase level.ê c) Carefully investigate the patient's allergy history before proceeding with anesthesia or surgery to implement preventive measures.

d) Note: some local anesthetics are lipophilic substances with high toxicity upon entering the body, causing severe poisoning similar to anaphylaxis that can lead to death within minutes. Immediate emergency treatment with antidotes (lipid emulsion) combined with adrenaline is required because it is impossible to determine immediately whether the reaction mechanism is due to poisoning or allergy.

e) Use antidote drugs such as Lipofundin 20%, Intralipid 20% administered intravenously quickly, which neutralize toxic substances from lipophilic anesthetics entering the bloodstream. Dosage as follows:development - Adults: total dose of 10ml/kg, including a bolus of 100ml, followed by intravenous infusion at 0.2-0.5ml/kg/min.

- Children: total dose of 10ml/kg, including a bolus of 2ml/kg, followed by intravenous infusion at 0.2-0.5ml/kg/min.

In severe cases, a second bolus injection may be given several minutes apart.

3. Anaphylaxis with Contrast Media

a) Anaphylaxis with contrast media mainly occurs through a non-allergic mechanism.

b) It is recommended to use contrast media with low osmotic pressure and non-ionizing (lower anaphylaxis rate).

II. Other Special Cases

1. Exercise-induced Anaphylaxis

a) This type of anaphylaxis appears after strenuous exercise.

b) Typical symptoms include feeling tired, exhaustion, flushing, redness, itching, urticaria, angioedema, wheezing, upper airway obstruction, shock. Some patients only exhibit symptoms when exercising with additional triggering factors such as food, non-steroidal anti-inflammatory drugs, alcohol, pollen.

c) Patients must stop physical activity immediately upon the first appearance of symptoms. They should carry an emergency anaphylaxis kit or pre-filled epinephrine auto-injectors (EpiPen, AnaPen...) with them. Treatment according to Appendix III issued together with this Circular.

d) Refer to Allergy-Immunology Clinic for screening the cause.

2. Idiopathic Anaphylaxisắa) Idiopathic anaphylaxis is diagnosed when anaphylactic symptoms occur without identifying a cause.No.b) Treatment according to Appendix III issued together with this Circular.No.c) Preventive treatment: indicated for patients experiencing frequent anaphylactic episodes (more than 6 times/year or more than 2 episodes/2 months).

d) Preventive treatment regimen:ứ- Prednisolone 60-100mg/day for one week, then

- Prednisolone 60mg/every other day for three weeks, then

- Gradually reduce the prednisolone dose over two months

- Antihistamines: cetirizine 10mg/day, loratadine 10mg/day...

EMERGENCY KIT FOR ANAPHYLAXIS AND MEDICAL EQUIPMENT

I. Components of the Emergency Kit for Anaphylaxis:lProtocol and Diagrams for Emergency Anaphylaxis Treatment (Appendix III, Appendix X)

Sterile Syringe Pump

- Type 1

- Type 5ml

- 14-16G Needle

Alcohol-Impregnated Sterile Swabs1Package/Box 10Tourniquet

 

ANNEX V

Adrenaline
(Issued together with Circular No. 51/2017/TT-BYT dated December 29, 2017 of the Minister of Health)

mg/

(see the model card stipulated in Appendix VII issued together with this Circular)

1Name of Drug or Allergen

Yes/

No

Clinical Manifestations-Treatment

Which medication or allergen caused the allergy?

Allergic to which insect?

Allergic to which food?

 

ANNEX VI

Allergic to other agents: pollen, dust, chemicals, cosmetics...?
(Issued together with Circular No. 51/2017/TT-BYT dated December 29, 2017 of the Minister of Health)

Effective intention Personal history of allergic diseases? (allergic rhinitis, asthma...) Family history of allergic diseases? (parents, children, siblings, anyone with these allergic conditions).

 

ANNEX VII

Clinical Manifestations
Physician confirms diagnosis and signs:/Date of Issue... of the Minister of Health)

(Front Side)

 

(Back Side)

 

ANNEX VIII

c) Sterilize the test site (wide areas without skin damage such as the inner forearm, back, etc.), wait for it to dry.
d) Use a sterile syringe ofrime Minister cml to inject subcutaneously at points spaced 3-5cm apart, each point 0.02-0.05ml forming a 3mm diameter papule in sequence.
(Issued together with Circular No. 51/2017/TT-BYT dated December 29, 2017 of the Minister of Health)

- Point 1: 0.9% sodium chloride solution (negative control).

- Point 2: standardized drug or allergen solution.onDifferent allergens must be used.

3. When conducting tests, emergency rescue equipment for allergic reactions must be available.

4. The skin testing procedure shall be carried out in accordance with Appendix IX issued together with this Circular.

5. If the patient has a history of drug allergy or allergen allergy and the skin test result (scratch or intradermal) is positive, such drug or allergen shall not be used.rime Minister c6. If the patient has a history of drug allergy or allergen allergy and the scratch skin test result is negative for that allergen, continue with the intradermal test.No.7. If the patient has a history of drug allergy and both the scratch skin test and intradermal test results are negative for the drug or allergen, in emergency situations, the drug must be used (there is no substitute drug).

8. In cases where the allergic condition stabilizes after 4-6 weeks, a follow-up examination by an allergy-immunology specialist or other specialists trained in basic clinical allergy-immunology should be conducted to determine the cause of the allergic reaction. The patient or their legal representative must give written consent for the provocation and/or rapid desensitization test with the drug at an allergy specialty department or doctors trained in clinical allergy-immunology at facilities capable of managing anaphylactic emergencies.

PROCEDURE FOR SKIN TESTING TECHNIQUESNo.1. SCRATCH TESTNo.a) Explain to the patient or their legal representative and sign the test request form.No.b) Prepare the equipment (scratch needle, sterile syringe needles, histamine solution 0.01 mg/ml, result measurement ruler, emergency anaphylaxis kit, standardized drugs or allergens).policiesc) Disinfect the test site (wide areas without skin damage such as the inner side of the forearm, back), wait until dry.ầd) Place drops spaced 3-5 cm apart, mark them to avoid confusion.ắ- One drop of 0.9% sodium chloride solution (negative control).

- One drop of suspected drug or allergen solution.

 

ANNEX IX

- One drop of histamine solution 0.01 mg/ml (positive control).
(Issued together with Circular No. 51/2017/TT-BYT dated December 29, 2017 of the Minister of Health)

e) Insert the scratch needle at a 45-degree angle between the droplets on the skin surface and gently scratch (without bleeding); if using a single-ended plastic needle with a stop, simply press the needle straight through the droplet perpendicular to the skin surface, then use paper or cotton to absorb the droplet after performing the technique.

f) Read the results after 20 minutes; a positive result is indicated when the wheal at the allergen site is larger than 3 mm or exceeds 75% compared to the negative control.

2. INTRADERMAL TESToa) Explain to the patient or their legal representative and sign the test request form. 1b) Prepare the equipment (0.9% sodium chloride solution, sterile syringe type 0.1 ml, result measurement ruler, emergency anaphylaxis kit, standardized drugs or allergens).n lc) Disinfect the test site (wide areas without skin damage such as the inner side of the forearm, back, etc.), wait until dry.

d) Using a 0.1 ml syringe, inject under the skin at points spaced 3-5 cm apart, each point 0.02-0.05 ml to create a raised wheal 3 mm in diameter in sequence.ograms and- Point 1: 0.9% sodium chloride solution (negative control).

- Point 2: standardized drug or allergen solution.

e) Read the results after 20 minutes; a positive result is indicated when the wheal at the allergen site is ≥ 3 mm or exceeds 75% compared to the negative control.

ANNEX X

DIAGNOSTIC AND MANAGEMENT FLOWCHART FOR ANAPHYLAXIS 1(Annexed to Circular No. 53/2017/TT-BYT dated December 29, 2017)

I. Detailed diagnostic and management flowchart for anaphylaxis^° II. Summary diagnostic and management flowchart for anaphylaxis

Note: The detailed diagnostic and management flowchart for anaphylaxis and the initial emergency management flowchart for anaphylaxis are recommended to be printed on large A3 or A2 paper and posted or hung in appropriate locations within healthcare facilities where medications are used./.

e) Read the results after 20 minutes, positive result when a wheal appears at the allergen site ≥ 3mm or more than 75% compared to the negative control./.

APPENDIX X

DIAGNOSTIC AND TREATMENT FLOWCHART FOR ANAPHYLAXISg (Attached to Circular No. 5 1/2017/TT-BYT dated December 29, 2017No.I. Detailed diagnostic and treatment flowchart for anaphylaxis

II. Summary diagnostic and treatment flowchart for anaphylaxis

Note: The detailed diagnostic and treatment flowchart for anaphylaxis and the initial emergency treatment flowchart for anaphylaxis are recommended to be printed on large A 1or A2 paper and posted or hung in appropriate locations where drugs are used in medical facilities./.

- Point 1: a 0.9% sodium chloride solution (negative control).

- Point 2: standardized drug solution or allergen.

e) Read the result after 20 minutes; a positive result is indicated when wheals appear at the allergen site ≥ 3mm or more than 75% compared to the negative control./.

 

ANNEX X

DIAGNOSTIC AND MANAGEMENT FLOWCHART FOR ANAPHYLAXIS
(Pursuant to Circular No. 51/2017/TT-BYT dated December 29, 2017 of the Minister of Health)

I. Detailed Diagnostic and Management Flowchart for Anaphylaxis

II. Summary Diagnostic and Management Flowchart for Anaphylaxis

Note: The detailed diagnostic and management flowchart for anaphylaxis and the initial emergency management flowchart for anaphylaxis are recommended to be printed on large A1 or A2 paper and posted or hung in appropriate locations within healthcare facilities where medications are used./.