Rationale
Anaphylaxis is a severe and potentially life-threatening allergic
reaction that all professionals working in healthcare and education
should be able to help recognise, manage and prevent. In Europe, about
one in 300 people will experience anaphylaxis at some time in their
lives.11Panesar SS, Javad S, de Silva D, Nwaru BI, Hickstein L,
Muraro A, Roberts G, Worm M, Bilò MB, Cardona V, Dubois AE, Dunn
Galvin A, Eigenmann P, Fernandez-Rivas M, Halken S, Lack G, Niggemann
B, Santos AF, Vlieg-Boerstra BJ, Zolkipli ZQ, Sheikh A.. The
epidemiology of anaphylaxis in Europe: a systematic review. Allergy
2013;68(11):1353-1361. The number of emergency department visits and
hospitalisations associated with anaphylaxis is increasing.22Turner
PJ, Gowland MH, Sharma V, Ierodiakonou D, Harper N, Garcez T, Pumphrey
R, Boyle RJ. Increase in anaphylaxis-related hospitalizations but no
increase in fatalities: an analysis of United Kingdom national
anaphylaxis data, 1992-2012. J Allergy Clin Immunol
2015;135(4):956-963.e1.
Rapid and effective care has an important role in keeping the rate of
deaths low,33Umasunthar T, Leonardi-Bee J, Hodes M, Turner PJ,
Gore C, Habibi P, Warner JO, Boyle RJ. Incidence of fatal food
anaphylaxis in people with food allergy: a systematic review and
meta-analysis. Clin Exp Allergy 2013;43(12):1333-1341. but delayed or
ineffective diagnosis and treatment is associated with unnecessary
social, psychological and health burden as well as extra
costs.44Lindor RA, McMahon EM, Wood JP, Sadosty AT, Boie ET,
Campbell RL. Anaphylaxis-related malpractice lawsuits. West J Emerg
Med 2018;19(4):693-700. It is essential that patients, families,
health professionals and teachers remain up-to-date with ways to
diagnose, manage and prevent anaphylaxis, particularly as potential
triggers such as food allergy and medication use rise.55Anagnostou
K. Anaphylaxis in children: epidemiology, risk factors and management.
Curr Pediatr Rev 2018;14(3):180-186.
In 2014, the European Academy of Allergy and Clinical Immunology (EAACI)
released guidelines for managing anaphylaxis.66Muraro A, Halken
S, Arshad SH, Beyer K, Dubois AE, Du Toit G, Eigenmann PA, Grimshaw
KE, Hoest A, Lack G, O’Mahony L. EAACI food allergy and anaphylaxis
guidelines. Primary prevention of food allergy. Allergy
2014;69(5):590-601. Since that time, new research has been published
and the EAACI guideline is being updated. This manuscript describes a
systematic review to support the guideline.
A number of other systematic reviews have examined
anaphylaxis.77Liyanage CK, Galappatthy P, Seneviratne SL.
Corticosteroids in management of anaphylaxis; a systematic review of
evidence. Eur Ann Allergy Clin Immunol 2017;49(5):196-207.,88Nurmatov
UB, Rhatigan E, Simons FE, Sheikh A.H2-antihistamines for the
treatment of anaphylaxis with and without shock: a systematic review.
Ann Allergy Asthma Immunol 2014;112(2):126-131.,99Dhami
S, Sheikh A, Muraro A, Roberts G, Halken S, Fernandez Rivas M, Worm M,
Sheikh A. Quality indicators for the acute and long-term management of
anaphylaxis: a systematic review. Clin Transl Allergy 2017;7:15.,1010Tomasiak-Łozowska
MM, Klimek M, Lis A, Moniuszko M, Bodzenta-Łukaszyk A. Markers of
anaphylaxis - a systematic review. Adv Med Sci 2018;63(2):265-277.,1111Chipps
BE. Update in pediatric anaphylaxis: a systematic review. Clin Pediatr
2013;52(5):451-461.,1212Choo KJ, Simons E,
Sheikh A. Glucocorticoids for the treatment of anaphylaxis: Cochrane
systematic review. Allergy 2010;65(10):1205-1211.,1313Sheikh
A, Ten Broek V, Brown SG, Simons FE. H1-antihistamines for the
treatment of anaphylaxis: Cochrane systematic review. Allergy
2007;62(8):830-837.,1414Nurmatov U, Worth A,
Sheikh A. Anaphylaxis management plans for the acute and long-term
management of anaphylaxis: a systematic review. J Allergy Clin Immunol
2008;122(2):353-61, 361.e1-3. However, none provide the broad, up to
date review that is required to inform and update the EAACI guideline. A
recent systematic review for an American Practice Parameter contains
useful information about the risk factors for biphasic anaphylaxis and
the prophylactic use of glucocorticoids and antihistamine
premedication.1515Shaker MS, Wallace DV, Golden DBK, Oppenheimer
J, Bernstein JA, Campbell RL, Dinakar C, Ellis A, Greenhawt M, Khan
DA, Lang DM, Lang ES, Lieberman JA, Portnoy J, Rank MA, Stukus DR,
Wang J. Anaphylaxis - a 2020 practice parameter update, systematic
review, and Grading of Recommendations, Assessment, Development and
Evaluation (GRADE) analysis. J Allergy Clin Immunol
2020;145(4):1082-1123. However EAACI’s guideline will cover a much
wider range of interventions to diagnose, treat and manage anaphylaxis,
and as such available reviews alone are not sufficient to inform the new
guideline.