Adrenaline for the treatment of anaphylaxis with and without shock

Azimullah, Sheikh; Shehata, Yasser; Brown, Simon G A; Simons, F. E. R.

doi:10.1002/14651858.cd006312

Cited by 24 publications

(8 citation statements)

References 28 publications

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“…1. Adrenaline (epinephrine) is pivotal in management and, in the recommended doses, causes vasoconstriction, bronchodilation, increased cardiac output, reduced mucosal oedema, and reduced mediator release (Level IV evidence, Grade C recommendation) 7,19 . 2.…”

Section: Immediate Managementmentioning

confidence: 99%

Australian and New Zealand Anaesthetic Allergy Group/ Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines

Kolawole

Marshall

Crilly

et al. 2017

Anaesth Intensive Care

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Anaphylaxis is an uncommon but important cause of serious morbidity and even mortality in the perioperative period. The Australian and New Zealand College of Anaesthetists (ANZCA) with the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) have developed clinical management guidelines that include six crisis management cards. The content of the guidelines and cards is based on published literature and other international guidelines for the management of anaesthesia-related and non-anaesthesia-related anaphylaxis. The evidence is summarised in the associated background paper (Perioperative Anaphylaxis Management Guidelines [2016] www.anzca.edu.au/resources/endorsed-guidelines and www.anzaag.com/Mgmt%20Resources.aspx). These guidelines are intended to apply to anaphylaxis occurring only during the perioperative period. They are not intended to apply to anaphylaxis outside the setting of dedicated monitoring and management by an anaesthetist. In this paper guidelines will be presented along with a brief background to their development.

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Section: Immediate Managementmentioning

confidence: 99%

Australian and New Zealand Anaesthetic Allergy Group/ Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines

Kolawole

Marshall

Crilly

et al. 2017

Anaesth Intensive Care

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“…We identified 15 studies: four systematic reviews (including one update), four RCTs , two case series and five fatality register‐based reports (including two updates) on the effectiveness of adrenaline.…”

Section: Acute Management Of Anaphylaxismentioning

confidence: 99%

“…The second case series found that a fifth of children experiencing anaphylaxis needed more than one dose of adrenaline; healthcare professionals administered this second dose in 94% of cases. The five fatality register‐based reports provided important insights into the difficulties of predicting the severity of subsequent reactions, risk factors for fatality, co‐existing asthma and the under‐issuing, poor carriage, under‐use, delayed use and incorrect use of adrenaline auto‐injectors. These reports revealed that fatalities can occur, even if adrenaline is used correctly.…”

Section: Acute Management Of Anaphylaxismentioning

confidence: 99%

Management of anaphylaxis: a systematic review

Dhami¹,

Panesar

Roberts

et al. 2013

Allergy

114

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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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“…We began with H 1 ‐antihistamines because they are the most commonly used treatment for anaphylaxis (17, 18). A critical appraisal of the evidence base for treatment with adrenaline in anaphylaxis will be published shortly (19), and this will be followed by a Cochrane Collaboration review investigating the role of glucocorticoids in anaphylaxis treatment. In all these reviews, we seek to focus on the highest order evidence, namely, that derived from randomized, controlled trials, but in the absence of such trials, to make reference to findings from other investigations with less reliable study designs.…”

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confidence: 99%