1. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis
- Author
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Marcus S. Shaker, Dana V. Wallace, David B.K. Golden, John Oppenheimer, Jonathan A. Bernstein, Ronna L. Campbell, Chitra Dinakar, Anne Ellis, Matthew Greenhawt, David A. Khan, David M. Lang, Eddy S. Lang, Jay A. Lieberman, Jay Portnoy, Matthew A. Rank, David R. Stukus, Julie Wang, Natalie Riblet, Aiyana M.P. Bobrownicki, Teresa Bontrager, Jarrod Dusin, Jennifer Foley, Becky Frederick, Eyitemi Fregene, Sage Hellerstedt, Ferdaus Hassan, Kori Hess, Caroline Horner, Kelly Huntington, Poojita Kasireddy, David Keeler, Bertha Kim, Phil Lieberman, Erin Lindhorst, Fiona McEnany, Jennifer Milbank, Helen Murphy, Oriana Pando, Ami K. Patel, Nicole Ratliff, Robert Rhodes, Kim Robertson, Hope Scott, Audrey Snell, Rhonda Sullivan, Varahi Trivedi, and Azadeh Wickham
- Subjects
Allergen immunotherapy ,medicine.medical_specialty ,Epinephrine ,medicine.medical_treatment ,Immunology ,Histamine Antagonists ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Risk Factors ,medicine ,Hypersensitivity ,Immunology and Allergy ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Anaphylaxis ,Glucocorticoids ,Evidence-Based Medicine ,business.industry ,medicine.disease ,030228 respiratory system ,Desensitization, Immunologic ,Practice Guidelines as Topic ,Number needed to treat ,Premedication ,Antihistamine ,business ,Adverse drug reaction ,medicine.drug - Abstract
Anaphylaxis is an acute, potential life-threatening systemic allergic reaction that may have a wide range of clinical manifestations. Severe anaphylaxis and/or the need for repeated doses of epinephrine to treat anaphylaxis are risk factors for biphasic anaphylaxis. Antihistamines and/or glucocorticoids are not reliable interventions to prevent biphasic anaphylaxis, although evidence supports a role for antihistamine and/or glucocorticoid premedication in specific chemotherapy protocols and rush aeroallergen immunotherapy. Evidence is lacking to support the role of antihistamines and/or glucocorticoid routine premedication in patients receiving low- or iso-osmolar contrast material to prevent recurrent radiocontrast media anaphylaxis. Epinephrine is the first-line pharmacotherapy for uniphasic and/or biphasic anaphylaxis. After diagnosis and treatment of anaphylaxis, all patients should be kept under observation until symptoms have fully resolved. All patients with anaphylaxis should receive education on anaphylaxis and risk of recurrence, trigger avoidance, self-injectable epinephrine education, referral to an allergist, and be educated about thresholds for further care.
- Published
- 2019