Management of anaphylaxis: a systematic review |
| |
| Authors: | S. Dhami S. S. Panesar G. Roberts A. Muraro M. Worm M. B. Bilò V. Cardona A. E. J. Dubois A. DunnGalvin P. Eigenmann M. Fernandez‐Rivas S. Halken G. Lack B. Niggemann F. Rueff A. F. Santos B. Vlieg‐Boerstra Z. Q. Zolkipli A. Sheikh the EAACI Food Allergy Anaphylaxis Guidelines Group |
| |
| Affiliation: | 1. Evidence‐Based Health Care Ltd, , Edinburgh, UK;2. Allergy & Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, , Edinburgh, UK;3. David Hide Asthma and Allergy Research Centre, St Mary's Hospital, , Newport, Isle of Wight, UK;4. NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, , Southampton, UK;5. Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, , Southampton, UK;6. Padua General University Hospital, , Padua, Italy;7. Allergy‐Center‐Charité, Department of Dermatology and Allergy, Charité – Universit?tsmedizin, , Berlin, Germany;8. University Hospital Ospedali Riuniti, , Ancona, Italy;9. Hospital Vall d'Hebron, , Barcelona, Spain;10. Department of Paediatrics, Division of Paediatric Pulmonology and Paediatric Allergy, and GRIAC Research Institute University Medical Centre Groningen, University of Groningen, , Groningen, the Netherlands;11. Department of Paediatrics and Child Health, University College, , Cork, Ireland;12. Children's Hospital, , Geneva, Switzerland;13. Allergy Department, Hospital Clinico San Carlos, IdISSC, , Madrid, Spain;14. Hans Christian Andersen Children's Hospital, Odense University Hospital, , Odense, Denmark;15. Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, , London;16. King's Health Partners, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, , London, UK;17. Allergy Center Charité, University Hospital Charité, , Berlin, Germany;18. Department of Dermatology and Allergy, Ludwig‐Maximilian University, , Munich, Germany;19. Immunoallergology Department, Coimbra University Hospital, , Coimbra, Portugal;20. Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, , Amsterdam, the Netherlands;21. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, , Boston, MA, USA |
| |
| 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. |
| |
| Keywords: | adrenaline anaphylaxis antihistamines emergency management plans immunotherapy |
|
|
