Diagnosis of anaphylaxis at presentation (Table 2)
We included three studies with 516 participants about the immediate
diagnosis of people presenting with anaphylaxis (as opposed to
retrospectively confirming a suspected diagnosis). Other approaches such
as serum tryptase are not summarised here because they help with
subsequent confirmation rather than immediate diagnosis.
The National Institute of Allergy and Infectious Disease and the Food
Allergy and Anaphylaxis Network (NIAID/FAAN) criteria aim to define
anaphylaxis for research and clinical purposes. It is unclear whether
these criteria help to diagnose anaphylaxis because the certainty of
evidence is very low, but there are positive trends (supplement S4a and
Table 2).
Sensitivity is an important indicator of the accuracy of criteria for
the immediate diagnosis of anaphylaxis. The NIAID/FAAN criteria may be
highly sensitive, but less specific. There were three eligible studies
in adults and children. One consecutive case series found that the
NIAID/FAAN criteria had sensitivity of 0.95 (95% confidence interval
(CI) 0.85 to 0.99) and specificity of 0.71 (95% CI 0.61 to 0.79, very
low certainty).11Loprinzi Brauer CE, Motosue MS, Li JT, Hagan
JB, Bellolio MF, Lee S, Campbell RL. Prospective validation of the
NIAID/FAAN criteria for emergency department diagnosis of anaphylaxis.
J Allergy Clin Immunol Pract 2016;4(6):1220-1226. A case-control
study found sensitivity of 97% (95% CI 89% to 99%) and specificity
of 82% (95% CI 76% to 88%, very low certainty).22Campbell
RL, Hagan JB, Manivannan V, Decker WW, Kanthala AR, Bellolio MF, Smith
VD, Li JT. Evaluation of national institute of allergy and infectious
diseases/food allergy and anaphylaxis network criteria for the
diagnosis of anaphylaxis in emergency department patients. J Allergy
Clin Immunol 2012;129(3):748-52. Another case control study found
sensitivity of 0.67 (95% CI 0.46 to 0.75) and specificity of 0.70 (0.59
to 0.80, very low certainty)33Erlewyn-Lajeunesse M, Dymond S,
Slade I, Mansfield HL, Fish R, Jones O, Benger JR. Diagnostic utility
of two case definitions for anaphylaxis: a comparison using a
retrospective case notes analysis in the UK. Drug Saf
2010;33(1):57-64.
The Brighton Collaboration case definition is designed for standardising
adverse events following immunisations. It includes many different
adverse effects to vaccines, not solely anaphylaxis. It is unclear
whether this definition helps to diagnose anaphylaxis because the
certainty of evidence is very low (supplement S4b). One case control
study found that this definition had sensitivity of 0.68 (95% CI 0.54
to 0.80) and specificity of 0.91 (95% CI 0.80 to 0.96) in children and
adults (very low certainty).44Erlewyn-Lajeunesse M, Dymond S,
Slade I, Mansfield HL, Fish R, Jones O, Benger JR. Diagnostic utility
of two case definitions for anaphylaxis: a comparison using a
retrospective case notes analysis in the UK. Drug Saf
2010;33(1):57-64.