The diagnosis and management of anaphylaxis practice parameter: 2010 Update

Lieberman, Phillip; Nicklas, Richard A.; Oppenheimer, John; Kemp, Stephen F.; Lang, David M.; Bernstein, David I.; Bernstein, Jonathan A.; Burks, A. Wesley; Feldweg, Anna M.; Fink, Jordan N.; Greenberger, Paul A.; Golden, David B.K.; James, John M.; Ledford, Dennis K.; Sheffer, Albert L.; Blessing-Moore, Joann; Cox, Linda; Khan, David A.; Portnoy, Jay M.; Randolph, Christopher; Schuller, Diane E.; Spector, Sheldon L.; Tilles, Stephen A.; Wallace, Dana

doi:10.1016/j.jaci.2010.06.022

Cited by 664 publications

(911 citation statements)

References 281 publications

(330 reference statements)

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“…Thirty-two of 196 (16.3%) respondents stated that their EDs used a definition based on an established set of criteria (question 2): 17 of these respondents (8.9% of the total) reported using definitions based on consensus criteria recommended by the NIAID/FAAN 2nd Symposium[5] (1.6%), the 2010 US Practice Parameters[4] (4.2%), or the WAO guidelines[3,6] (3.1%) as the source of their definition.…”

Section: Resultsmentioning

confidence: 99%

“…Are the current clinical criteria for identifying anaphylaxis as published in the National Institutes of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) 2 nd Symposium,[5] the 2010 US Practice Parameters,[4] or the World Allergy Organization (WAO) Guidelines,[3,6] being applied in clinical practice? Treatment. Is epinephrine being used as the first-line agent for treating all episodes of anaphylaxis-even those with mild or single system symptoms and those in which the diagnosis is only suspected?…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

Russell

Farrar

Nowak

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers. The study aimed to evaluate how emergency departments (EDs) in the United States (US) manage anaphylaxis in relation to guideline recommendations.METHODS:This was an online anonymous survey of a random sample of EM health providers in US EDs.RESULTS:Data analysis included 207 EM providers. For respondent EDs, approximately 9% reported using agreed-upon clinical criteria to diagnose anaphylaxis; 42% reported administering epinephrine in the ED for most anaphylaxis episodes; and <50% provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge. Most provided some written materials, and follow-up with a primary care clinician was recommended.CONCLUSIONS:This is the first cross-sectional survey to provide “real-world” data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine. Prospective research is recommended.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

Russell

Farrar

Nowak

et al. 2013

World Journal of Emergency Medicine

View full text Add to dashboard Cite

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“…mastocytosis, asthma). 10,23,24 In dogs, the triggers of urticaria and/ or anaphylaxis that are supported by original studies or case reports are vaccines, 25 anaesthetics, 26,27 food, 28,29 venoms, [30][31][32] drugs, 1,17 glucocorticoids, 33 transfusions, 34 plants 35 and radiocontrast media. 36 Some rare causes such as heat, exercise, sunlight, dermatographism, estrous, intestinal parasites, allergen-specific immunotherapy and intradermal testing are only anecdotally reported in veterinary textbooks.…”

Section: Introductionmentioning

confidence: 99%

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

Rostaher¹,

Hofer‐Inteeworn

Kümmerle‐Fraune

et al. 2017

Advances in Veterinary Dermatology

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Background -Urticaria and anaphylaxis are frequently encountered in veterinary practice, but little is known about the causes and relative frequencies of these reactions.Hypothesis/Objectives -This study was designed to improve current knowledge on the triggers, risk factors and clinico-pathological features of urticaria.Animals -Twenty four dogs with signs of urticaria with or without anaphylaxis.Methods -The study included dogs with cutaneous immediate-type hypersensitivity reactions. The cases were grouped by clinical severity into either an urticaria or an anaphylaxis group. All treatments and diagnostic tests (haematology, biochemical profile, allergy investigation) were recorded. A causality algorithm for urticaria and anaphylaxis (ALUA) was designed to determine the probability of the identified triggers and cofactors. Disease incidence, breed, age and gender predispositions were evaluated statistically.Results -Sixteen of 24 urticaria cases were associated with anaphylaxis whilst 8 of 24 were confined to the skin. The annual hospital incidence was 0.12%. Females seemed to be over-represented (2.4:1) and most of the dog breeds were pure breed (22 of 24), with Rhodesian ridgeback, boxer, beagle, Jack Russell terrier, French bulldog and Vizslas over-represented. In addition to skin lesions, the most frequently and severely affected organ systems were the gastrointestinal and cardiovascular systems. The predominant blood abnormalities were elevated lipase and alanine aminotransferase values. Insects, food and drugs were the most commonly identified triggers.Conclusions -To the best of our knowledge, this is the first study describing the trigger factors and clinicopathological features of dogs with urticaria in veterinary medicine. Insects, food and drugs were the most frequently detected triggers.

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“…Patients chronically medicated with β‐blockers and/or angiotensin‐converting enzyme inhibitors are potentially at risk for development of unresponsiveness to adrenaline 42. In such patients, vasopressin,43 methylene blue,44 and glucagon33, 42, 45 might be effective.…”

Section: Initial Treatment Of Anaphylaxismentioning

confidence: 99%

Drug‐induced anaphylaxis in the emergency room

Takazawa

Oshima

Saito

2017

Acute Medicine & Surgery

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Anaphylaxis is a life‐threatening, systemic allergic reaction that presents unique challenges for emergency care practitioners. Anaphylaxis occurs more frequently than previously believed. Therefore, proper knowledge regarding the epidemiology, mechanisms, symptoms, diagnosis, and treatment of anaphylaxis is essential. In particular, the initial treatment strategy, followed by correct diagnosis, in the emergency room is critical for preventing fatal anaphylaxis, although making a diagnosis is not easy because of the broad and often atypical presentation of anaphylaxis. To this end, the clinical criteria proposed by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network are useful, which, together with a differential diagnosis, could enable a more accurate diagnosis. Additional in vitro tests, such as plasma histamine and tryptase measurements, are also helpful. It should be emphasized that adrenaline is the only drug recommended as first‐line therapy in all published national anaphylaxis guidelines. Most international anaphylaxis guidelines recommend injecting adrenaline by the intramuscular route in the mid‐anterolateral thigh, whereas i.v. adrenaline is an option for patients with severe hypotension or cardiac arrest unresponsive to intramuscular adrenaline and fluid resuscitation. In addition to the route of administration, choosing the appropriate dose of adrenaline is essential, because serious adverse effects can potentially occur after an overdose of adrenaline. Furthermore, to avoid future recurrence of anaphylaxis, providing adrenaline auto‐injectors and making an etiological diagnosis, including confirmation of the offending trigger, are recommended for patients at risk of anaphylaxis before their discharge from the emergency room.

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The diagnosis and management of anaphylaxis practice parameter: 2010 Update

Cited by 664 publications

References 281 publications

Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

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

Drug‐induced anaphylaxis in the emergency room

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