BACKGROUND: Diagnostic criteria were proposed at the Second Symposium on the Definition and Management of Anaphylaxis convened by the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN). Validation is needed before these criteria can be widely adapted into clinical practice. OBJECTIVE: Our aim was to retrospectively assess the diagnostic accuracy of the NIAID/FAAN criteria for the diagnosis of anaphylaxis in emergency department (ED) patients. METHODS: A retrospective cohort study of ED patients presenting from April to October 2008 was conducted. Patients given a diagnosis of an allergic reaction or anaphylaxis and a subset of patients with related diagnoses were included. Electronic medical records were reviewed and data were abstracted to determine whether the NIAID/FAAN criteria were met. Records were also independently reviewed in a blinded fashion by 2 experienced attending allergists. Final diagnosis by allergists was considered the reference standard. RESULTS: Of 214 patients, 86 (40.2%) met the NIAID/FAAN criteria for anaphylaxis. Allergists gave 61 (28.5%) patients diagnoses of anaphylaxis, 59 (96.7%) of whom satisfied the NIAID/FAAN criteria. The interrater agreement between allergists was substantial (κ = 0.77). The test characteristics of the NIAID/FAAN criteria were as follows: sensitivity, 96.7% (95% CI, 88.8% to 99.1%); specificity, 82.4% (95% CI, 75.5% to 87.6%); positive predictive value, 68.6% (95% CI, 58.2% to 77.4%); negative predictive value, 98.4% (95% CI, 94.5% to 99.6%); positive likelihood ratio, 5.48; and negative likelihood ratio, 0.04. CONCLUSIONS: These results suggest that the NIAID/FAAN criteria are highly sensitive but less specific and are likely to be useful in the ED for the diagnosis of anaphylaxis.
BACKGROUND: Diagnostic criteria were proposed at the Second Symposium on the Definition and Management of Anaphylaxis convened by the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN). Validation is needed before these criteria can be widely adapted into clinical practice. OBJECTIVE: Our aim was to retrospectively assess the diagnostic accuracy of the NIAID/FAAN criteria for the diagnosis of anaphylaxis in emergency department (ED) patients. METHODS: A retrospective cohort study of ED patients presenting from April to October 2008 was conducted. Patients given a diagnosis of an allergic reaction or anaphylaxis and a subset of patients with related diagnoses were included. Electronic medical records were reviewed and data were abstracted to determine whether the NIAID/FAAN criteria were met. Records were also independently reviewed in a blinded fashion by 2 experienced attending allergists. Final diagnosis by allergists was considered the reference standard. RESULTS: Of 214 patients, 86 (40.2%) met the NIAID/FAAN criteria for anaphylaxis. Allergists gave 61 (28.5%) patients diagnoses of anaphylaxis, 59 (96.7%) of whom satisfied the NIAID/FAAN criteria. The interrater agreement between allergists was substantial (κ = 0.77). The test characteristics of the NIAID/FAAN criteria were as follows: sensitivity, 96.7% (95% CI, 88.8% to 99.1%); specificity, 82.4% (95% CI, 75.5% to 87.6%); positive predictive value, 68.6% (95% CI, 58.2% to 77.4%); negative predictive value, 98.4% (95% CI, 94.5% to 99.6%); positive likelihood ratio, 5.48; and negative likelihood ratio, 0.04. CONCLUSIONS: These results suggest that the NIAID/FAAN criteria are highly sensitive but less specific and are likely to be useful in the ED for the diagnosis of anaphylaxis.
Authors: Timothy E Dribin; Hugh A Sampson; Carlos A Camargo; David C Brousseau; Jonathan M Spergel; Mark I Neuman; Marcus Shaker; Ronna L Campbell; Kenneth A Michelson; Susan A Rudders; Amal H Assa'ad; Kimberly A Risma; Mariana Castells; Lynda C Schneider; Julie Wang; Juhee Lee; Rakesh D Mistry; David Vyles; Lisa M Vaughn; Daniel J Schumacher; John K Witry; Shiv Viswanathan; Erica M Page; David Schnadower Journal: J Allergy Clin Immunol Date: 2020-08-24 Impact factor: 10.793
Authors: Joanna S Cohen; Chisom Agbim; Michael Hrdy; Mary E Mottla; Monika K Goyal; Kristen Breslin Journal: Allergy Asthma Proc Date: 2021-03-01 Impact factor: 2.587
Authors: David M Fleischer; Matthew Greenhawt; Gordon Sussman; Philippe Bégin; Anna Nowak-Wegrzyn; Daniel Petroni; Kirsten Beyer; Terri Brown-Whitehorn; Jacques Hebert; Jonathan O'B Hourihane; Dianne E Campbell; Stephanie Leonard; R Sharon Chinthrajah; Jacqueline A Pongracic; Stacie M Jones; Lars Lange; Hey Chong; Todd D Green; Robert Wood; Amarjit Cheema; Susan L Prescott; Peter Smith; William Yang; Edmond S Chan; Aideen Byrne; Amal Assa'ad; J Andrew Bird; Edwin H Kim; Lynda Schneider; Carla M Davis; Bruce J Lanser; Romain Lambert; Wayne Shreffler Journal: JAMA Date: 2019-03-12 Impact factor: 56.272