Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review

Abstract

To cite this article: Choo KJL, Simons E, Sheikh A. Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review. Allergy 2010; 65: 1205–1211.AbstractBackground: Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may result in death. A number of guidelines recommend glucocorticoids for the treatment of people experiencing anaphylaxis.Objectives: We sought to assess the benefits and harms of glucocorticoid treatment during episodes of anaphylaxis.Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 3), MEDLINE (Ovid) (1966 to September 2009), EMBASE (Ovid) (1988 to September 2009), CINAHL (EBSCOhost) (to September 2009) and The Science Citation Index Expanded (SCI‐EXPANDED) (1945 to September 2009). We also searched the UK National Research Register and websites listing ongoing trials and contacted international experts in anaphylaxis in an attempt to locate unpublished material. We sought to include randomized and quasi‐randomized controlled trials comparing glucocorticoids with any control (either placebo, adrenaline (epinephrine), an antihistamine, or any combination of these). Two authors independently assessed articles for inclusion.Results: None of the 2496 reports identified satisfied the inclusion criteria.Conclusions: We conclude that there is no evidence from high‐quality studies for the use of steroids in the emergency management of anaphylaxis. Therefore, we can neither support nor refute the use of these drugs for this purpose.

Practical Guidelines for Perioperative Hypersensitivity Reactions

“…Systematic reviews suggest that these drugs are not useful for the treatment of anaphylaxis [57,58].…”

Actualización en las recomendaciones del tratamiento del choque anafiláctico: novedades sobre el uso de adrenalina

“…Sin embargo, debido a su amplio uso y a la imposibilidad ética, en muchos casos, de realizar estudios aleatorizados, los autores concluyen que, aun sin evidencias firmes, no se puede desaconsejar su uso. 49,50 Es imperativa la necesidad de la observación clínica posterior al tratamiento del paciente con choque anafiláctico debido a la posibilidad de una reacción retardada 51 y de anafilaxia bifásica.…”

Anaphylaxis: Etiology, Clinical Manifestations, Diagnosis and Management

“…The common side effect is emesis, particularly related with rapid infusion and therefore protection of the airways to prevent aspiration in severely drowsy patients is important (Lee & Vadas, 2011;Lieberman et al, 2010). A recent Cochrane systematic review concluded that there is insufficient high-quality evidence to either support or not to support the use of glucocorticosteroids in the management of anaphylaxis (Choo et al, 2010). The existing evidence consists mainly of retrospective studies, case reports, and other descriptive literature.…”

“…Other guidelines recommend hydrocortisone, triamcinolone, prednisone by intravenous, intramuscular, or oral routes using different doses and dose regimens (Soar, 2005, Brown et al, 2006, Alrasbi & Sheikh, 2007, Muraro et al, 2007, as cited in Choo et al, 2010. Short term glucocorticoid treatment is seldom associated with adverse effects (Choo et al, 2010). Additionally short and rapid acting 2-adrenergic agonist, salbutamol is recommended in nebulised form in doses of 2.5 mg/3 mL in children or 5 mg/3 mL in adults to treat bronchoconstriction with combination of oxygen supplementation (Simons et al, 2011).…”