Lessons for management of anaphylaxis from a study of fatal reactions

Pumphrey, R. S. H.

doi:10.1046/j.1365-2222.2000.00864.x

Cited by 971 publications

(802 citation statements)

References 30 publications

(31 reference statements)

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“…We identified a further eight articles from the reference lists of relevant articles (n = 5) and hand searches of allergy journals (n = 3), but none were found from searching the gray literature. Of the total of 84 articles that were considered for review in full text, 59 met the inclusion/exclusion criteria and were included in the systematic review (1,4,9,11,) (see Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…We identified 202 gaps in anaphylaxis management across the 59 studies (1,4,9,11,. Using grounded theory methodology (17), two authors independently categorized these gaps according to major themes and classified the frequency of these themes from the perspective of two broad populations: physicians (primary care, pediatricians, and allergy specialists) and patients or the community (schools, Potentially relevant articles identified (n = 5014) MEDLINE (n = 1306), EMBASE (n = 1899), CINAHL (n = 953), and EBM reviews* (n = 856); Grey literature (n = 0):…”

Section: Resultsmentioning

confidence: 99%

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Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature

Kastner

Harada

Waserman

2010

Allergy

117

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To cite this article: Kastner M, Harada L, Waserman S. Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature. Allergy 2010; 65: 435–444.AbstractDiagnosis and management of anaphylaxis can be a challenge because reactions are often unexpected and progress quickly. The focus of anaphylaxis management has mostly been on the acute episode, with little attention given to the long‐term management of patients at risk. This is compounded by conflicting information in current guidelines and a general lack of agreement among clinicians about which management strategies are the most appropriate. We systematically reviewed the literature to identify and summarize studies that investigated gaps in anaphylaxis management. Our search included MEDLINE, EMBASE, CINAHL, and Evidence‐Based Medicine Reviews. Studies were included if they addressed an outcome describing gaps in anaphylaxis knowledge, education, anaphylaxis management, and quality of life (QOL). Populations of interest were health care professionals involved in the care of patients at risk for anaphylaxis, and patients of any age, their parents, caregivers, and teachers in primary care, hospital or community settings. Of 5014 citations that were identified, the final 59 studies (selected from 75 full‐text articles) met the inclusion criteria. Two hundred and two gaps were identified and classified according to major themes: gaps in knowledge and anaphylaxis management (physicians and patients); gaps in follow‐up care (physicians); and QOL of patients and caregivers. Findings from this systematic review revealed gaps in anaphylaxis management at the level of physicians, patients, and the community. Findings will be used to provide a basis for developing interventional strategies to help address these deficiencies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature

Kastner

Harada

Waserman

2010

Allergy

117

View full text Add to dashboard Cite

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“…3,[5][6][7][8][9][10][11][12][13][14][15][16][17] In areas where resources are limited, it is particularly important to ensure that epinephrine (adrenaline) is injected intramuscularly as soon as anaphylaxis is recognized because the initial first-aid dose of 0.01 mg/kg is low compared with the dose for cardiopulmonary resuscitation, and if injected late in patients with cardiorespiratory failure or shock, it is likely to be ineffective. [27][28][29][30][31][32] The epinephrine dose can be repeated several times, every 5 to 15 minutes, if needed. 19 …”

Section: Essentials For Anaphylaxis Assessment and Managementmentioning

confidence: 99%

World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings

Simons

2010

Annals of Allergy, Asthma & Immunology

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BACKGROUND: The availability of anaphylaxis guidelines and of medications, supplies, and equipment for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings worldwide is unknown. OBJECTIVE: To ascertain the global availability of these essentials. METHODS: A survey instrument was developed and sent by e-mail in 2008 to a nonrandomized convenience sample of representative leading allergy-immunology specialists in 52 countries identified through the World Allergy Organization. Responses were analyzed by country. RESULTS: Surveys were returned from 44 of 52 countries on 6 continents, for an 85% response rate. Anaphylaxis guidelines were reported to be in use in 70% of the 44 responding countries. The diagnosis of acute anaphylaxis was reported to be based on clinical history and physical examination alone in 63% of responding countries. Medications for anaphylaxis treatment were reported to be available in the 44 responding countries as follows: epinephrine (adrenaline) for injection, 100%; any intravenous glucocorticoid, 89%; any intravenous H1-antihistamine, 77%; any intravenous H2-antihistamine, 70%; glucagon, 73%; atropine, 73%; dopamine, 86%; noradrenaline, 70%; vasopressin, 64%; and a beta 2-agonist for nebulization, 86%. Supplies and equipment for anaphylaxis treatment were reported to be available in responding countries as follows: for giving supplemental oxygen, 95%; for intubation, 89%; for giving intravenous fluid resuscitation, 91%; for monitoring oxygenation using pulse oximetry, 91%; and for continuous noninvasive blood pressure and cardiac monitoring, 81%. CONCLUSIONS: Allergy-immunology specialists reported that except for epinephrine ampules life-saving essentials for the assessment and management of anaphylaxis in health care settings were not universally available worldwide in 2008. Background: The availability of anaphylaxis guidelines and of medications, supplies, and equipment for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings worldwide is unknown.Objective: To ascertain the global availability of these essentials. Methods: A survey instrument was developed and sent by e-mail in 2008 to a nonrandomized convenience sample of representative leading allergy-immunology specialists in 52 countries identified through the World Allergy Organization. Responses were analyzed by country.Results: Surveys were returned from 44 of 52 countries on 6 continents, for an 85% response rate. Anaphylaxis guidelines were reported to be in use in 70% of the 44 responding countries. The diagnosis of acute anaphylaxis was reported to be based on clinical history and physical examination alone in 63% of responding countries. Medications for anaphylaxis treatment were reported to be available in the 44 responding countries as follows: epinephrine (adrenaline) for injection, 100%; any intravenous glucocorticoid, 89%; any intravenous H 1 -antihistamine, 77%; any intravenous H 2 -antihistamine, 70%; glucagon...

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“…It should be recognised, however, that anaphylaxis is a dynamic event during which multiple symptoms may come and go but which, once recognised, must be promptly treated to prevent further development of systemic features. 4 A working diagnosis of anaphylaxis can usually be made by identifying features of a systemic allergic reaction accompanied by either respiratory difficulty or features suggestive of hypotension. 5…”

Section: Clinical Featuresmentioning

confidence: 99%

“…1 This figure is however likely to represent something of an underestimate because deaths from drug allergy and a proportion of deaths in those with a history of asthma and unexpected deaths may have been misclassified.…”

Section: Introductionmentioning

confidence: 96%