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Diagnosing, managing and preventing anaphylaxis: systematic review
  • +23
  • Debra de Silva,
  • Chris Singh,
  • Antonella Muraro,
  • Margitta Worm,
  • Cherry Alviani,
  • Victoria Cardona,
  • Audrey DunnGalvin,
  • Lene Garvey,
  • CARMEN RIGGIONI,
  • Elisabeth Angier,
  • Stefania Arasi,
  • Abdelouahab Bellou,
  • Kirsten Beyer,
  • Diola Bijlhout,
  • M Beatrice Bilo,
  • Knut Brockow,
  • Montserrat Fernandez-Rivas,
  • Susanne Halken,
  • Britt Jensen,
  • Ekaterina Khaleva,
  • Louise Michaelis,
  • Hanneke Oude Elberink,
  • Lynne Regent,
  • Berber Vlieg - Boerstra,
  • Angel Sanchez San,
  • Graham Roberts
Debra de Silva
The Evidence Centre

Corresponding Author:debra@evidencecentre.com

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Chris Singh
The Evidence Centre
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Antonella Muraro
Padua General University Hospital
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Margitta Worm
Charité - Universitätsmedizin Berlin
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Cherry Alviani
University of Southampton
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Victoria Cardona
Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron
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Audrey DunnGalvin
University College Cork (UCC)
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Lene Garvey
Copenhagen University Hospital Gentofte
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CARMEN RIGGIONI
Hospital Sant Joan de Déu
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Elisabeth Angier
University of Southampton
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Stefania Arasi
Universita degli Studi di Messina
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Abdelouahab Bellou
European Society for Emergency Medicine
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Kirsten Beyer
Charité Universitätsmedizin Berlin
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Diola Bijlhout
Association for Teacher Education in Europe (ATEE)
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M Beatrice Bilo
University Hospital of Ancona Umberto I G M Lancisi G Salesi
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Knut Brockow
Technical University of Munich
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Montserrat Fernandez-Rivas
Hospital Clinico San Carlos
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Susanne Halken
University of Southern Denmark, Odense
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Britt Jensen
Odense University Hospital, University of Southern Denmark
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Ekaterina Khaleva
University of Southampton
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Louise Michaelis
Great North Children's Hospital
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Hanneke Oude Elberink
University Medical Center Groningen
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Lynne Regent
The Anaphylaxis Campaign
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Berber Vlieg - Boerstra
Onze Lieve Vrouwe Gasthuis
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Angel Sanchez San
Asociación Española de Personas con Alergia a Alimentos y Látex
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Graham Roberts
University of Southampton
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Abstract

Background This systematic review used the GRADE approach to compile evidence to inform an anaphylaxis guideline from the European Academy of Allergy and Clinical Immunology (EAACI). Methods We searched five bibliographic databases from 1946 to 20 April 2020 for studies about the diagnosis, management and prevention of anaphylaxis. We included 50 studies with 18,449 participants: 29 randomised controlled trials, seven controlled clinical trials, seven consecutive case series and seven case-control studies. Findings were summarised narratively because studies were too heterogeneous to conduct meta-analysis. Results It is unclear whether the NIAID/FAAN criteria or Brighton case definition are valid for immediately diagnosing anaphylaxis due to the very low certainty of evidence. Adrenaline is the cornerstone of first-line emergency management of anaphylaxis but, due to ethical constraints, little robust research has assessed its effectiveness . Newer models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce time to administration. Face-to-face training for laypeople may slightly improve anaphylaxis knowledge and competence in using autoinjectors. Adrenaline prophylaxis prior to snake bite anti-venom may reduce anaphylaxis but the impact of prophylactic corticosteroids and antihistamines is uncertain. There was insufficient evidence about the impact of other anaphylaxis management strategies. Conclusions Anaphylaxis is a potentially life-threatening condition but, due to practical and ethical challenges, there is a paucity of robust evidence about how to diagnose and manage it.
15 Jun 2020Submitted to Allergy
16 Jun 2020Submission Checks Completed
16 Jun 2020Assigned to Editor
25 Jun 2020Reviewer(s) Assigned
13 Jul 2020Review(s) Completed, Editorial Evaluation Pending
14 Jul 2020Editorial Decision: Revise Minor
27 Jul 20201st Revision Received
28 Jul 2020Submission Checks Completed
28 Jul 2020Assigned to Editor
30 Jul 2020Reviewer(s) Assigned
13 Aug 2020Review(s) Completed, Editorial Evaluation Pending
13 Aug 2020Editorial Decision: Revise Minor
13 Aug 20202nd Revision Received
14 Aug 2020Submission Checks Completed
14 Aug 2020Assigned to Editor
15 Aug 2020Review(s) Completed, Editorial Evaluation Pending
17 Aug 2020Editorial Decision: Accept
May 2021Published in Allergy volume 76 issue 5 on pages 1493-1506. 10.1111/all.14580