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Management of anaphylaxis: a systematic review

Management of anaphylaxis: a systematic review
Management of anaphylaxis: a systematic review
To establish the effectiveness of interventions for the acute and long-term management of anaphylaxis, seven databases were searched for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series and - only in relation to adrenaline - case series investigating the effectiveness of interventions in managing anaphylaxis. Fifty-five studies satisfied the inclusion criteria. We found no robust studies investigating the effectiveness of adrenaline (epinephrine), H1-antihistamines, systemic glucocorticosteroids or methylxanthines to manage anaphylaxis. There was evidence regarding the optimum route, site and dose of administration of adrenaline from trials studying people with a history of anaphylaxis. This suggested that administration of intramuscular adrenaline into the middle of vastus lateralis muscle is the optimum treatment. Furthermore, fatality register studies have suggested that a failure or delay in administration of adrenaline may increase the risk of death. The main long-term management interventions studied were anaphylaxis management plans and allergen-specific immunotherapy. Management plans may reduce the risk of further reactions, but these studies were at high risk of bias. Venom immunotherapy may reduce the incidence of systemic reactions in those with a history of venom-triggered anaphylaxis.
0105-4538
Dhami, S.
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Panesar, S.S.
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Roberts, Graham
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Muraro, A.
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Worm, M.
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Bilò, M.B.
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Cardona, V.
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Dubois, A.E.J.
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Dunngalvin, A.
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Eigenmann, P.
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Fernandez-Rivas, M.
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Halken, S.
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Lack, G.
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Niggeman, B.
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Rueff, F.
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Santos, A.E.
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Vlieg-Boerstra, B.
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Zolkipli, Z.Q.
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Sheikh, A.
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Dhami, S.
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Panesar, S.S.
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Roberts, Graham
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Muraro, A.
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Worm, M.
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Bilò, M.B.
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Cardona, V.
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Dubois, A.E.J.
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Dunngalvin, A.
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Eigenmann, P.
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Fernandez-Rivas, M.
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Halken, S.
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Lack, G.
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Niggeman, B.
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Rueff, F.
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Santos, A.E.
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Vlieg-Boerstra, B.
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Zolkipli, Z.Q.
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Sheikh, A.
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Dhami, S., Panesar, S.S., Roberts, Graham, Muraro, A., Worm, M., Bilò, M.B., Cardona, V., Dubois, A.E.J., Dunngalvin, A., Eigenmann, P., Fernandez-Rivas, M., Halken, S., Lack, G., Niggeman, B., Rueff, F., Santos, A.E., Vlieg-Boerstra, B., Zolkipli, Z.Q. and Sheikh, A. (2013) Management of anaphylaxis: a systematic review. Allergy. (doi:10.1111/all.12318). (PMID:24251536)

Record type: Article

Abstract

To establish the effectiveness of interventions for the acute and long-term management of anaphylaxis, seven databases were searched for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series and - only in relation to adrenaline - case series investigating the effectiveness of interventions in managing anaphylaxis. Fifty-five studies satisfied the inclusion criteria. We found no robust studies investigating the effectiveness of adrenaline (epinephrine), H1-antihistamines, systemic glucocorticosteroids or methylxanthines to manage anaphylaxis. There was evidence regarding the optimum route, site and dose of administration of adrenaline from trials studying people with a history of anaphylaxis. This suggested that administration of intramuscular adrenaline into the middle of vastus lateralis muscle is the optimum treatment. Furthermore, fatality register studies have suggested that a failure or delay in administration of adrenaline may increase the risk of death. The main long-term management interventions studied were anaphylaxis management plans and allergen-specific immunotherapy. Management plans may reduce the risk of further reactions, but these studies were at high risk of bias. Venom immunotherapy may reduce the incidence of systemic reactions in those with a history of venom-triggered anaphylaxis.

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More information

Published date: 20 November 2013
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 360131
URI: http://eprints.soton.ac.uk/id/eprint/360131
ISSN: 0105-4538
PURE UUID: 3bfaabdf-9a07-486d-b00e-ef356c54e404
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 27 Nov 2013 13:12
Last modified: 15 Mar 2024 03:22

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Contributors

Author: S. Dhami
Author: S.S. Panesar
Author: Graham Roberts ORCID iD
Author: A. Muraro
Author: M. Worm
Author: M.B. Bilò
Author: V. Cardona
Author: A.E.J. Dubois
Author: A. Dunngalvin
Author: P. Eigenmann
Author: M. Fernandez-Rivas
Author: S. Halken
Author: G. Lack
Author: B. Niggeman
Author: F. Rueff
Author: A.E. Santos
Author: B. Vlieg-Boerstra
Author: Z.Q. Zolkipli
Author: A. Sheikh

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