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.