Management of anaphylaxis: a systematic review

Abstract

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.

EAACI Food Allergy and Anaphylaxis Guidelines: managing patients with food allergy in the community

“…In a study of children from 14 allergy clinics throughout UK, only 16.7% used their prescribed AAI during anaphylaxis (40). These data emphasize the importance of repeated education and assessment of the knowledge on how and when to use of AAI devices (37).…”

“…Indications for provision of AAIs are discussed in detail in the Anaphylaxis guideline (37). Some reports are a warning indication of AAI actual use, in comparison with AAI prescription.…”

Triggers, risk factors and clinico‐pathological features of urticaria in dogs – a prospective observational study of 24 cases

“…Anaphylaxis is a serious, generalized or systemic, allergic or hypersensitivity reaction with sudden onset (minutes to a few hours) that can be life threatening or even fatal. [8][9][10][11][12] The target organs in humans often include the respiratory tract (70% of episodes) and less frequently the gastrointestinal (GI) organs (30-45% of episodes), heart and vasculature (10-45% of episodes) and central nervous system (CNS) (10-15% of episodes). 8 It is generally agreed that anaphylaxis may occur with or without cutaneous signs, even though these latter signs are frequent and occur in 80-100% of cases.…”

Anaphylaxis: the “killer allergy”

“…Adrenaline and other modalities of treatment used in the management of anaphylaxis were introduced before the era of evidence-based medicine, and none of them have evidence from good quality randomized controlled trials to support their use. [10][11][12][13][14] However,the evidence base for adrenaline injection is stronger than for the other medications. 10,[13][14][15][16][17] Due to obvious ethical considerations, it is unlikely that more evidence will be generated from randomized clinical trials regarding the use of adrenaline in the treatment of anaphylaxis.…”

“…1,14,18 Intravenous adrenaline is recommended only for patients with severe anaphylaxis refractory to intramuscular adrenaline or those who are in severe shock. [1][2][3][4] In patients with a spontaneous circulation, intravenous adrenaline can cause life-threatening hypertension, tachycardia, arrhythmias, and myocardial ischaemia.…”