Eligibility criteria
Studies were eligible for the review if they included:
- Population : children (aged under 18 years) and/or adults (18+
years) with or without a history of anaphylaxis.
- Intervention : any intervention to immediately diagnose at
emergency presentation, manage or prevent anaphylaxis in the community
or hospital. Studies related to immunotherapy were excluded as these
are covered in other EAACI guidelines.11Muraro A, Roberts G,
Halken S, Agache I, Angier E, Fernandez-Rivas M, Gerth van Wijk R,
Jutel M, Lau S, Pajno G, Pfaar O, Ryan D, Sturm GJ, van Ree R, Varga
EM, Bachert C, Calderon M, Canonica GW, Durham SR, Malling HJ, Wahn
U, Sheikh A. EAACI guidelines on allergen immunotherapy: Executive
statement. Allergy 2018;73(4):739-743.
- Comparator : any comparator, including placebo, no intervention
or any intervention or combination of interventions.
- Outcomes : anaphylaxis incidence, sensitivity and specificity of
diagnostic approaches, mortality or near fatal incidents, hospital
admissions, quality of life and other pre-set outcomes.
- Study types : full publications of randomised controlled trials
(hereafter trials), controlled clinical trials, controlled
before-and-after studies and case-control studies in humans and, in
the case of diagnosis and adrenaline (epinephrine) only, consecutive
case series with a minimum of 20 participants. There were no language
or geographical restrictions.
- Timeframe : published from 1946 to 20 April 2020.
Previous reviews have identified limited trials about interventions to
prevent and manage anaphylaxis22Armstrong N, Wolff R, van
Mastrigt G, Martinez N, Hernandez AV, Misso K, Kleijnen J. A
systematic review and cost-effectiveness analysis of specialist
services and adrenaline auto- injectors in anaphylaxis. Health Technol
Assess 2013;17(17):1-117, v-vi.,33El Turki
A, Smith H, Llewellyn C, Jones CJ. A systematic review of patients’,
parents’ and healthcare professionals’ adrenaline auto-injector
administration techniques. Emerg Med J 2017;34(6):403-416.,44Tejedor-Alonso
MA, Farias-Aquino E, Pérez-Fernández E, Grifol-Clar E, Moro-Moro M,
Rosado-Ingelmo A. Relationship between anaphylaxis and use of
beta-blockers and angiotensin-converting enzyme inhibitors: a
systematic review and meta-analysis of observational studies. J
Allergy Clin Immunol Pract 2019;7(3):879-897.e5. so we included other
comparative designs. Consecutive case series were eligible when studying
diagnostic tests and adrenaline because expert advice suggested that it
is difficult and potentially unethical to implement more robust designs
in these areas. Registry studies, cohort studies and uncontrolled
before-and-after studies were excluded in order to focus on the most
robust comparative evidence.