Gaps between actual initial treatment of anaphylaxis in China and international guidelines: A review and analysis of 819 reported cases

Jiang, Chunyan; Li, Hongwei; Wang, Lina; Liu, Chunyan; Hao, Xiaofei

doi:10.1111/all.14090

Cited by 12 publications

(17 citation statements)

References 7 publications

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“…37 Similar to the present study, under-use of epinephrine has been reported in previous studies. 38,39 As the first-line treatment for anaphylaxis, epinephrine is recommended by guidelines. 1 The low rate of epinephrine utilization and its lack of use as the first-line therapy in our study could be contribute to initial failure to recognize anaphylactic reactions or worrying adverse reactions associated with use of epinephrine.…”

Section: Discussionmentioning

confidence: 99%

“…Previous published data in Chinese patients also demonstrated that there existed some critical gaps between actual treatment of anaphylaxis in China and international guidelines. In a review and analysis of 819 reported anaphylaxis cases in Chinese population, glucocorticoids (44.3%) was the most commonly used drugs, 39 and the percentage of glucocorticoids was 72% in another cohort of 907 Chinese patients. 23 The present study and previous published studies highlight that education and training on the initial treatment of anaphylaxis is strongly suggested for healthcare providers in China.…”

Section: Discussionmentioning

confidence: 99%

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Age-related differences in characteristics of anaphylaxis in Chinese children from infancy to adolescence

Jiang

2021

World Allergy Organization Journal

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Background Little is known about anaphylaxis in Chinese children. This study aimed to determine the age-specific patterns of anaphylaxis in Chinese children. Methods We conducted a retrospective study of anaphylaxis cases attending an allergy department in a tertiary children's hospital. Results A total of 279 anaphylactic reactions in 177 patients were analyzed. Overall, 57.6% (102/177) of first anaphylaxis events occurred in infants (0–2 ys). Foods were the most common culprits (88.5%), followed by food + exercise/exercise (4.7%), and drugs (4.3%). The main food allergens were cow's milk (32.9%), egg (21.4%), and wheat (20.7%) in infants, compared with fruits/vegetables at 35.9% in preschool-age children (3–6 ys) and 31.6% in school-age children (7–12 ys). The most commonly implicated drug triggers were vaccines (n = 5, comprising DTaP n = 2, group A + C meningococcal polysaccharide vaccine n = 1, Sabin vaccine n = 1, and not specified n = 1). Among the 5 vaccine-induced anaphylaxis patients, 4 had severe cow's milk allergy. The clinical manifestations were mainly mucocutaneous (86.0%), followed by respiratory (68.8%), gastrointestinal (23.7%), neurological (10.4%), and cardiovascular (0.7%). Compared with patients of other ages, infants had higher rates of hives (0-2ys 77.4%, 3-6ys 50%,7-12ys 57.9%, 13-17ys 38.9%, p = 0.016) and vomiting (0-2ys 20.7%, 3-6ys 1.6%,7-12ys 8.8%, p < 0.001), while wheezing was more frequent in school-age children (0-2ys 21.4%, 3-6ys 25%, 7-12ys 38.6%, 13-17ys 5.6%, p = 0.017) and abdominal pain was more common in adolescents (0-2ys 2.1%,3-6ys 15.6%, 7-12ys 14.0%, 13-17ys 72.3%, p < 0.001). Regarding treatment, 9.3% of anaphylaxis events and 24.1% of life-threatening reactions were treated with epinephrine. Conclusions We observed age-related clinical patterns of anaphylaxis in this study, with hives and vomiting most commonly reported in infants and cardiovascular symptoms rarely reported in children. Wheat was the third most culprit food allergen after egg and milk in infancy. Education regarding more aggressive use of epinephrine in the emergency setting is clearly needed. Recognition of age-related symptoms in anaphylaxis can aid physicians in prompt diagnosis and acute management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Age-related differences in characteristics of anaphylaxis in Chinese children from infancy to adolescence

Jiang

2021

World Allergy Organization Journal

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“…In addition, the problem of under-recognition and under-reporting still exists in some developing or underdeveloped countries in Asia. 100 Structured training of specialists in the field of pediatric allergy and clinical immunology is therefore required to improve the level of clinical care and research in areas with underdeveloped diagnostic expertise.…”

Section: Future Perspectivesmentioning

confidence: 99%

Environmental Influences and Allergic Diseases in the Asia-Pacific Region: What Will Happen in Next 30 Years?

Xing

Wong

2022

Allergy Asthma Immunol Res

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Asia-Pacific is a populous region with remarkable variations in socioeconomic development and environmental exposure among countries. The prevalence rates of asthma and allergic rhinitis appear to have recently reached a plateau in Western countries, whereas they are still increasing in many Asian countries. Given the large population in Asia, even a slight increase in the prevalence rate will translate into an overwhelming number of patients. To reduce the magnitude of the increase in allergic diseases in next few decades in Asia, we must understand the potential factors leading to the occurrence of these disorders and the development of potential preventive strategies. The etiology of allergic disorders is likely due to complex interactions among genetic, epigenetic, and environmental factors for the manifestations of inappropriate immune responses. As urbanization and industrialization inevitably progress in Asia, there is an urgent need to curtail the upcoming waves of the allergy epidemic. Potentially modifiable risk exposure, such as air pollution, should be minimized through timely implementation of effective legislations. Meanwhile, re-introduction of protective factors that were once part of the traditional farming lifestyle might give new insight into primary prevention of allergy.

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“…A crossover RCT reported that mild transient adverse reactions were slightly higher with IM compared with SC epinephrine (low-quality evidence)[( Simons et al, 2001 )]. A cohort study observed that there was no difference in the risk of overdose between IM and SC group [( Jiang et al, 2020 )].…”

Section: Resultsmentioning

confidence: 99%

“…Another cohort study also observed a lower risk of adverse cardiovascular event when compared to IV bolus (low-quality evidence) [( Campbell et al, 2015 )]. Besides, two cohort studies indicated a lower risk of overdose in comparison with IV bolus (very low-quality evidence)[( Campbell et al, 2015 ; Jiang et al, 2020 )]. However, there was no cardiovascular safety advantage for IM compared with IV infusion (very low-quality evidence) [( Campbell et al, 2015 )].…”

Section: Resultsmentioning

confidence: 99%

A Clinical Practice Guideline for the Emergency Management of Anaphylaxis (2020)

Yin

et al. 2022

Front. Pharmacol.

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Background: For anaphylaxis, a life-threatening allergic reaction, the incidence rate was presented to have increased from the beginning of the 21st century. Underdiagnosis and undertreatment of anaphylaxis are public health concerns.Objective: This guideline aimed to provide high-quality and evidence-based recommendations for the emergency management of anaphylaxis.Method: The panel of health professionals from fifteen medical areas selected twenty-five clinical questions and formulated the recommendations with the supervision of four methodologists. We collected evidence by conducting systematic literature retrieval and using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.Results: This guideline made twenty-five recommendations that covered the diagnosis, preparation, emergency treatment, and post-emergency management of anaphylaxis. We recommended the use of a set of adapted diagnostic criteria from the American National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network (NIAID/FAAN), and developed a severity grading system that classified anaphylaxis into four grades. We recommended epinephrine as the first-line treatment, with specific doses and routes of administration for different severity of anaphylaxis or different conditions. Proper dosage is critical in the administration of epinephrine, and the monitor is important in the IV administration. Though there was only very low or low-quality evidence supported the use of glucocorticoids and H1 antagonists, we still weakly recommended them as second-line medications. We could not make a well-directed recommendation regarding premedication for preventing anaphylaxis since it is difficult to weigh the concerns and potential effects.Conclusion: For the emergency management of anaphylaxis we conclude that:• NIAID/FAAN diagnostic criteria and the four-tier grading system should be used for the diagnosis• Prompt and proper administration of epinephrine is critical.

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Gaps between actual initial treatment of anaphylaxis in China and international guidelines: A review and analysis of 819 reported cases

Cited by 12 publications

References 7 publications

Age-related differences in characteristics of anaphylaxis in Chinese children from infancy to adolescence

Age-related differences in characteristics of anaphylaxis in Chinese children from infancy to adolescence

Environmental Influences and Allergic Diseases in the Asia-Pacific Region: What Will Happen in Next 30 Years?

A Clinical Practice Guideline for the Emergency Management of Anaphylaxis (2020)

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