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Diagnosing, managing and preventing anaphylaxis: systematic review

Diagnosing, managing and preventing anaphylaxis: systematic review
Diagnosing, managing and preventing anaphylaxis: systematic review

BACKGROUND: This systematic review used the GRADE approach to compile evidence to inform the European Academy of Allergy and Clinical Immunology's (EAACI) anaphylaxis guideline.

METHODS: We searched five bibliographic databases from 1946 to 20 April 2020 for studies about the diagnosis, management and prevention of anaphylaxis. We included 50 studies with 18,449 participants: 29 randomised controlled trials, seven controlled clinical trials, seven consecutive case series and seven case-control studies. Findings were summarised narratively because studies were too heterogeneous to conduct meta-analysis.

RESULTS: It is unclear whether the NIAID/FAAN criteria or Brighton case definition are valid for immediately diagnosing anaphylaxis due to the very low certainty of evidence. There was also insufficient evidence about the impact of most anaphylaxis management and prevention strategies. Adrenaline is regularly used for first-line emergency management of anaphylaxis but little robust research has assessed its effectiveness. Newer models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce time to administration. Face-to-face training for laypeople may slightly improve anaphylaxis knowledge and competence in using autoinjectors. We searched for but found little or no comparative effectiveness evidence about strategies such as fluid replacement, oxygen, glucocorticosteroids, methylxanthines, bronchodilators, management plans, food labels, drug labels and similar.

CONCLUSIONS: Anaphylaxis is a potentially life-threatening condition but, due to practical and ethical challenges, there is a paucity of robust evidence about how to diagnose and manage it.

adrenaline, anaphylaxis, diagnosis, epinephrine, management, prevention
0105-4538
de Silva, Debra
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Singh, Chris
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Muraro, Antonella
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Worm, Margitta
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Alviani, Cherry
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Cardona, Victoria
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DunnGalvin, Audrey
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Garvey, Lene Heise
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Riggioni, Carmen
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Angier, Elizabeth
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Arasi, Stefania
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Bellou, Abdelouahab
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Beyer, Kirsten
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Bijlhout, Diola
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Bilo, M. Beatrice
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Brockow, Knut
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Fernandez-Rivas, Montserrat
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Halken, Susanne
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Jensen, Britt
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Khaleva, Ekaterina
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Michaelis, Louise J.
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Oude Elberink, Hanneke
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Sanchez, Angel
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Vlieg-Boerstra, Berber
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Roberts, Graham
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European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group
de Silva, Debra
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Singh, Chris
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Muraro, Antonella
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Worm, Margitta
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Alviani, Cherry
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Cardona, Victoria
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DunnGalvin, Audrey
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Garvey, Lene Heise
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Riggioni, Carmen
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Angier, Elizabeth
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Arasi, Stefania
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Bellou, Abdelouahab
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Beyer, Kirsten
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Bijlhout, Diola
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Bilo, M. Beatrice
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Brockow, Knut
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Fernandez-Rivas, Montserrat
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Halken, Susanne
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Jensen, Britt
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Khaleva, Ekaterina
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Michaelis, Louise J.
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Oude Elberink, Hanneke
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Regent, Lynne
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Sanchez, Angel
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Vlieg-Boerstra, Berber
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Roberts, Graham
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de Silva, Debra, Singh, Chris, Muraro, Antonella, Worm, Margitta, Alviani, Cherry, Cardona, Victoria, DunnGalvin, Audrey, Garvey, Lene Heise, Riggioni, Carmen, Angier, Elizabeth, Arasi, Stefania, Bellou, Abdelouahab, Beyer, Kirsten, Bijlhout, Diola, Bilo, M. Beatrice, Brockow, Knut, Fernandez-Rivas, Montserrat, Halken, Susanne, Jensen, Britt, Khaleva, Ekaterina, Michaelis, Louise J., Oude Elberink, Hanneke, Regent, Lynne, Sanchez, Angel, Vlieg-Boerstra, Berber and Roberts, Graham , European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group (2020) Diagnosing, managing and preventing anaphylaxis: systematic review. Allergy. (doi:10.1111/all.14580).

Record type: Article

Abstract

BACKGROUND: This systematic review used the GRADE approach to compile evidence to inform the European Academy of Allergy and Clinical Immunology's (EAACI) anaphylaxis guideline.

METHODS: We searched five bibliographic databases from 1946 to 20 April 2020 for studies about the diagnosis, management and prevention of anaphylaxis. We included 50 studies with 18,449 participants: 29 randomised controlled trials, seven controlled clinical trials, seven consecutive case series and seven case-control studies. Findings were summarised narratively because studies were too heterogeneous to conduct meta-analysis.

RESULTS: It is unclear whether the NIAID/FAAN criteria or Brighton case definition are valid for immediately diagnosing anaphylaxis due to the very low certainty of evidence. There was also insufficient evidence about the impact of most anaphylaxis management and prevention strategies. Adrenaline is regularly used for first-line emergency management of anaphylaxis but little robust research has assessed its effectiveness. Newer models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce time to administration. Face-to-face training for laypeople may slightly improve anaphylaxis knowledge and competence in using autoinjectors. We searched for but found little or no comparative effectiveness evidence about strategies such as fluid replacement, oxygen, glucocorticosteroids, methylxanthines, bronchodilators, management plans, food labels, drug labels and similar.

CONCLUSIONS: Anaphylaxis is a potentially life-threatening condition but, due to practical and ethical challenges, there is a paucity of robust evidence about how to diagnose and manage it.

Text
all.14580 - Accepted Manuscript
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More information

Accepted/In Press date: 17 August 2020
e-pub ahead of print date: 2 September 2020
Keywords: adrenaline, anaphylaxis, diagnosis, epinephrine, management, prevention

Identifiers

Local EPrints ID: 443968
URI: http://eprints.soton.ac.uk/id/eprint/443968
ISSN: 0105-4538
PURE UUID: bb1873f5-46de-4403-a03f-934c7f6a27c7
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

Catalogue record

Date deposited: 18 Sep 2020 16:31
Last modified: 08 Jan 2022 07:35

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Contributors

Author: Debra de Silva
Author: Chris Singh
Author: Antonella Muraro
Author: Margitta Worm
Author: Cherry Alviani
Author: Victoria Cardona
Author: Audrey DunnGalvin
Author: Lene Heise Garvey
Author: Carmen Riggioni
Author: Elizabeth Angier
Author: Stefania Arasi
Author: Abdelouahab Bellou
Author: Kirsten Beyer
Author: Diola Bijlhout
Author: M. Beatrice Bilo
Author: Knut Brockow
Author: Montserrat Fernandez-Rivas
Author: Susanne Halken
Author: Britt Jensen
Author: Ekaterina Khaleva
Author: Louise J. Michaelis
Author: Hanneke Oude Elberink
Author: Lynne Regent
Author: Angel Sanchez
Author: Berber Vlieg-Boerstra
Author: Graham Roberts ORCID iD
Corporate Author: European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group

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