Antonella Muraro, Margitta Worm and Graham Roberts equally contributed as guideline chairs.This paper sets out the updated European Academy of Allergy and Clinical Immunology's (EAACI) guideline regarding the diagnosis, acute management, and prevention of anaphylaxis. Anaphylaxis is a clinical emergency and all healthcare professionals need to be familiar with its recognition and management. Anaphylaxis is a lifethreatening reaction characterized by acute onset of symptoms involving different organ systems and requiring immediate medical intervention. 1 Although the fatality rate due to anaphylaxis remains low, 2 the frequency of hospitalization from food and drug-induced anaphylaxis has been increasing in recent years. 3 The symptoms of anaphylaxis are highly variable. 4,5 Data from patients experiencing anaphylaxis revealed that skin and mucosal symptoms occur most frequently (>90% of cases) followed by symptoms involving the respiratory and cardiovascular systems (>50%). Food, drug, and Hymenoptera venom are the most common elicitors of anaphylactic reactions. 5,6 The prevalence of the various causes of anaphylaxis are age-dependent and vary in different geographical regions. In Europe, typical causes of food-induced anaphylaxis in children are peanut, hazelnut, milk, and egg and in adults, wheat, celery, and shellfish; fruits such as peach are also typical causes of food-induced anaphylaxis in adults in some European countries such as Spain and Italy. 7,8 Venom-induced anaphylaxis is typically caused by wasp and bee venom. 9 Drug-induced anaphylaxis is typically caused by antibiotics and non-steroidal anti-inflammatory drugs. 10,11 Among antibiotics, beta-lactam antibiotics are the leading eliciting allergens. 12 At times, there is an occupational cause. 13 Co-factors may be aggravating factors in anaphylaxis, examples are exercise, stress, infection, non-steroidal anti-inflammatory drugs, and alcohol. [14][15][16] In some cases, the cause is not obvious (idiopathic anaphylaxis) and investigations for rarer allergens or differential diagnoses should be considered. [17][18][19] This guideline, updated from 2014, 20 provides evidence-based guidance to help manage anaphylaxis. The primary audience is clinical allergists (specialists and subspecialists), primary care, paediatricians, emergency physicians, anaesthetists and intensivists, nurses, dieticians, and other healthcare professionals. The guideline was

BackgroundPrebiotics and probiotics (synbiotics) can modify gut microbiota and have potential in allergy management when combined with amino-acid-based formula (AAF) for infants with cow’s milk allergy (CMA).MethodsThis multicenter, double-blind, randomized controlled trial investigated the effects of an AAF-including synbiotic blend on percentages of bifidobacteria and Eubacterium rectale/Clostridium coccoides group (ER/CC) in feces from infants with suspected non-IgE-mediated CMA. Feces from age-matched healthy breastfed infants were used as reference (healthy breastfed reference (HBR)) for primary outcomes. The CMA subjects were randomized and received test or control formula for 8 weeks. Test formula was a hypoallergenic, nutritionally complete AAF including a prebiotic blend of fructo-oligosaccharides and the probiotic strain Bifidobacterium breve M-16V. Control formula was AAF without synbiotics.ResultsA total of 35 (test) and 36 (control) subjects were randomized; HBR included 51 infants. At week 8, the median percentage of bifidobacteria was higher in the test group than in the control group (35.4% vs. 9.7%, respectively; P<0.001), whereas ER/CC was lower (9.5% vs. 24.2%, respectively; P<0.001). HBR levels of bifidobacteria and ER/CC were 55% and 6.5%, respectively.ConclusionAAF including specific synbiotics, which results in levels of bifidobacteria and ER/CC approximating levels in the HBR group, improves the fecal microbiota of infants with suspected non-IgE-mediated CMA.

Prophylactic HDM oral immunotherapy is well tolerated in children at high heredity risk. The results met the trial's prespecified criteria for proof of concept in reducing sensitization to any allergen; however, no significant preventive effect was observed on HDM sensitization or allergy-related symptoms.