Debra de Silva1, Chris Singh1, Antonella Muraro2, Margitta Worm3, Cherry Alviani4, Victoria Cardona5,6, Audrey DunnGlvin7,8, Lene Heise Garvey9,10, Carmen Riggioni11, Elizabeth Angier12, Stefania Arasi13, Abdelouahab Bellou14, Kirsten Beyer15, Diola Bijlhout16, M Beatrice Bilo17,18, Knut Brockow19, Montserrat Fernandez-Rivas20, Susanne Halken21, Britt Jensen22, Ekaterina Khaleva4, Louise J Michaelis23, Hanneke Oude Elberink24,25, Lynne Regent26, Angel Sanchez27, Berber Vlieg-Boerstra28,29, Graham Roberts4,30,31. 1. The Evidence Centre Ltd, London, UK. 2. Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy. 3. Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin, Berlin, Germany. 4. Faculty of Medicine, Clinical and Experimental Sciences and Human Development in Health, University of Southampton, Southampton, UK. 5. Department of Internal Medicine, Allergy Section, Hospital Vall d'Hebron, Barcelona, Spain. 6. ARADyAL Research Network, Cáceres, Spain. 7. University College Cork, Cork, UK. 8. Sechnov University Moscow, Moscow, Russia. 9. Department of Dermatology and Allergy, Allergy Clinic, Gentofte Hospital, Hellerup, Denmark. 10. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 11. Paediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Deu and Sant Joan de Deu Research Foundation, Barcelona, Spain. 12. Primary Care and Population Sciences, University of Southampton, Southampton, UK. 13. Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Bambino Gesù Hospital IRCCS, Rome, Italy. 14. European Society for Emergency Medicine, Brussels, Belgium. 15. Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany. 16. Association for Teacher Education in Europe (ATEE), Brussels, Belgium. 17. Allergy Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy. 18. Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy. 19. Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany. 20. Allergy Department, Hospital Clinico San Carlos, Facultad Medicina Universidad Complutense, IdISSC, ARADyAL, Madrid, Spain. 21. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark. 22. Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark. 23. Paediatric Allergy Research, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK. 24. Department of Allergology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 25. Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands. 26. Anaphylaxis Campaign, Farnborough, UK. 27. AEPNAA Spanish Association for People with Food and Latex Allergy, Madrid, Spain. 28. Department of Paediatrics, OLVG, Amsterdam, The Netherlands. 29. Department of Nutrition & Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands. 30. NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 31. The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
Abstract
BACKGROUND: This systematic review used the GRADE approach to compile evidence to inform the European Academy of Allergy and Clinical Immunology's (EAACI) anaphylaxis guideline. METHODS: We searched five bibliographic databases from 1946 to 20 April 2020 for studies about the diagnosis, management and prevention of anaphylaxis. We included 50 studies with 18 449 participants: 29 randomized controlled trials, seven controlled clinical trials, seven consecutive case series and seven case-control studies. Findings were summarized narratively because studies were too heterogeneous to conduct meta-analysis. RESULTS: It is unclear whether the NIAID/FAAN criteria or Brighton case definition are valid for immediately diagnosing anaphylaxis due to the very low certainty of evidence. There was also insufficient evidence about the impact of most anaphylaxis management and prevention strategies. Adrenaline is regularly used for first-line emergency management of anaphylaxis but little robust research has assessed its effectiveness. Newer models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce time to administration. Face-to-face training for laypeople may slightly improve anaphylaxis knowledge and competence in using autoinjectors. We searched for but found little or no comparative effectiveness evidence about strategies such as fluid replacement, oxygen, glucocorticosteroids, methylxanthines, bronchodilators, management plans, food labels, drug labels and similar. CONCLUSIONS: Anaphylaxis is a potentially life-threatening condition but, due to practical and ethical challenges, there is a paucity of robust evidence about how to diagnose and manage it.
BACKGROUND: This systematic review used the GRADE approach to compile evidence to inform the European Academy of Allergy and Clinical Immunology's (EAACI) anaphylaxis guideline. METHODS: We searched five bibliographic databases from 1946 to 20 April 2020 for studies about the diagnosis, management and prevention of anaphylaxis. We included 50 studies with 18 449 participants: 29 randomized controlled trials, seven controlled clinical trials, seven consecutive case series and seven case-control studies. Findings were summarized narratively because studies were too heterogeneous to conduct meta-analysis. RESULTS: It is unclear whether the NIAID/FAAN criteria or Brighton case definition are valid for immediately diagnosing anaphylaxis due to the very low certainty of evidence. There was also insufficient evidence about the impact of most anaphylaxis management and prevention strategies. Adrenaline is regularly used for first-line emergency management of anaphylaxis but little robust research has assessed its effectiveness. Newer models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce time to administration. Face-to-face training for laypeople may slightly improve anaphylaxis knowledge and competence in using autoinjectors. We searched for but found little or no comparative effectiveness evidence about strategies such as fluid replacement, oxygen, glucocorticosteroids, methylxanthines, bronchodilators, management plans, food labels, drug labels and similar. CONCLUSIONS: Anaphylaxis is a potentially life-threatening condition but, due to practical and ethical challenges, there is a paucity of robust evidence about how to diagnose and manage it.
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