Abstract
Anaphylaxis is a clinical emergency which all healthcare professionals need to be able to recognize and manage. The European Academy of Allergy and Clinical Immunology Anaphylaxis multidisciplinary Task Force has updated the 2014 guideline. The guideline was developed using the AGREE II framework and the GRADE approach. The evidence was systematically reviewed and recommendations were created by weighing up benefits and harms. The guideline was peer-reviewed by external experts and reviewed in a public consultation. The use of clinical criteria to identify anaphylaxis is suggested with blood sampling for the later measurement of tryptase. The prompt use of intramuscular adrenaline as first-line management is recommended with the availability of adrenaline autoinjectors to patients in the community. Pharmacokinetic data should be provided for adrenaline autoinjector devices. Structured, comprehensive training for people at risk of anaphylaxis is recommended. Simulation training and visual prompts for healthcare professionals are suggested to improve the management of anaphylaxis. It is suggested that school policies reflect anaphylaxis guidelines. The evidence for the management of anaphylaxis remains mostly at a very low level. There is an urgent need to prioritize clinical trials with the potential to improve the management of patients at risk of anaphylaxis.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Allergy |
| Vol/bind | 77 |
| Udgave nummer | 2 |
| Sider (fra-til) | 357-377 |
| Antal sider | 21 |
| ISSN | 0105-4538 |
| DOI | |
| Status | Udgivet - feb. 2022 |
Bibliografisk note
Funding Information:Professor Muraro reports grants and personal fees from Aimmune and personal fees from DVB, Mylan, ALK and Nestle outside the submitted work and was past President of EAACI. Professor Worm reports grants and personal fees from Stallergens, HAL Allergie, Bencard Allergie, Allergopharma, ALK‐Abello, Mylan Germany, Actelion Pharmaceuticals Deutschland, Biotest, AbbVie Deutschland, Lilly Deutschland Aimmune, DBV Technologies, Regeneron Pharmaceuticals, Sanofi Aventis, Leo Pharma, Novartis and Viatris, outside the submitted work and is past WAO co‐chair of the anaphylaxis committee. Dr. Alviani has nothing to disclose. Dr. Cardona reports personal fees from Allergopharma and GSK and a grant from Thermofisher outside the submitted work and SLAAI chair anaphylaxis committee plus past WAO chair anaphylaxis committee. Dr. DunnGalvin has nothing to disclose. Dr. Garvey reports personal fees from Novo Nordisk, Merck, Lundbeck, Biomarin and Thermofisher Scientific outside the submitted work. Dr. Riggioni has nothing to disclose. Professor de Silva has no conflict to disclose in relation to the guideline. Her organization received a grant from EAACI to conduct a systematic review, which was one of the tools the task force drew on tool when developing recommendations. Dr. Angier reports BSACI member and Anaphylaxis Campaign scientific board member. Dr. Arasi has nothing to disclose. Professor Bellou has nothing to disclose. Dr. Beyer reports grants and personal fees from Aimmune, grants and personal fees from ALK, grants and personal fees from Danone, grants and personal fees from DBV, grants and personal fees from Infectopharm, grants and personal fees from ThermoFisher, grants and personal fees from Hycor, grants from DST Diagnostic, Good Mills, Hipp, VDI, EU, German Research Foundation, BMBF and personal fees from Allergopharma, Bausch & Lomb, Bencard, Jenpharma, Mabylon, Mylan, Nestle, Novartis, and Nutricia outside the submitted work. Dr. Bijlhout has nothing to disclose. Dr Bilo reports personal fees from ALK, Allergy Therapeutics, Astra, GSK and Sanofi outside the submitted work. Prof Dr Bindslev‐Jensen reports research grants from Novartis outside the submitted work. Dr Brockow reports personal fees from ThermoFisher and Mylan outside the submitted work. Dr Fernandez‐Rivas reports grants from ISCIII (Ministry of Science, Spanish Government), grants and personal fees from Aimmune and personal fees from Ga2len, DBV, Novartis, SPRIM, Diater, GSK, HAL Allergy and Thermofisher Scientific outside the submitted work. Professor Halken has nothing to disclose. Dr Jensen has nothing to disclose. Dr. Khaleva has nothing to disclose. Dr Michaelis has nothing to disclose. Dr Oude Elberink reports grants from Pure IMS and Blueprint, support from Novartis, Behring, Viatric, Takeda and Sanofi outside the submitted work and is on the Advisory Board of PIMS Epinephrine. Ms Regent reports she is employed by the Anaphylaxis Campaign, UK; the organization received support from ALK‐Abello and Mylan. Dr Sanchez reports a personal fees from Aimmune Therapeutics outside the submitted work. Dr Vlieg‐Boerstra reports grants and personal fees from Nutricia and personal fees from Mead Johnson, Abbott and Marfo Food Groups outside the submitted work. Professor Roberts reports he was Editor in Chief Clinical & Experimental Allergy until December 2020.
Finansiering
Professor Muraro reports grants and personal fees from Aimmune and personal fees from DVB, Mylan, ALK and Nestle outside the submitted work and was past President of EAACI. Professor Worm reports grants and personal fees from Stallergens, HAL Allergie, Bencard Allergie, Allergopharma, ALK‐Abello, Mylan Germany, Actelion Pharmaceuticals Deutschland, Biotest, AbbVie Deutschland, Lilly Deutschland Aimmune, DBV Technologies, Regeneron Pharmaceuticals, Sanofi Aventis, Leo Pharma, Novartis and Viatris, outside the submitted work and is past WAO co‐chair of the anaphylaxis committee. Dr. Alviani has nothing to disclose. Dr. Cardona reports personal fees from Allergopharma and GSK and a grant from Thermofisher outside the submitted work and SLAAI chair anaphylaxis committee plus past WAO chair anaphylaxis committee. Dr. DunnGalvin has nothing to disclose. Dr. Garvey reports personal fees from Novo Nordisk, Merck, Lundbeck, Biomarin and Thermofisher Scientific outside the submitted work. Dr. Riggioni has nothing to disclose. Professor de Silva has no conflict to disclose in relation to the guideline. Her organization received a grant from EAACI to conduct a systematic review, which was one of the tools the task force drew on tool when developing recommendations. Dr. Angier reports BSACI member and Anaphylaxis Campaign scientific board member. Dr. Arasi has nothing to disclose. Professor Bellou has nothing to disclose. Dr. Beyer reports grants and personal fees from Aimmune, grants and personal fees from ALK, grants and personal fees from Danone, grants and personal fees from DBV, grants and personal fees from Infectopharm, grants and personal fees from ThermoFisher, grants and personal fees from Hycor, grants from DST Diagnostic, Good Mills, Hipp, VDI, EU, German Research Foundation, BMBF and personal fees from Allergopharma, Bausch & Lomb, Bencard, Jenpharma, Mabylon, Mylan, Nestle, Novartis, and Nutricia outside the submitted work. Dr. Bijlhout has nothing to disclose. Dr Bilo reports personal fees from ALK, Allergy Therapeutics, Astra, GSK and Sanofi outside the submitted work. Prof Dr Bindslev‐Jensen reports research grants from Novartis outside the submitted work. Dr Brockow reports personal fees from ThermoFisher and Mylan outside the submitted work. Dr Fernandez‐Rivas reports grants from ISCIII (Ministry of Science, Spanish Government), grants and personal fees from Aimmune and personal fees from Ga2len, DBV, Novartis, SPRIM, Diater, GSK, HAL Allergy and Thermofisher Scientific outside the submitted work. Professor Halken has nothing to disclose. Dr Jensen has nothing to disclose. Dr. Khaleva has nothing to disclose. Dr Michaelis has nothing to disclose. Dr Oude Elberink reports grants from Pure IMS and Blueprint, support from Novartis, Behring, Viatric, Takeda and Sanofi outside the submitted work and is on the Advisory Board of PIMS Epinephrine. Ms Regent reports she is employed by the Anaphylaxis Campaign, UK; the organization received support from ALK‐Abello and Mylan. Dr Sanchez reports a personal fees from Aimmune Therapeutics outside the submitted work. Dr Vlieg‐Boerstra reports grants and personal fees from Nutricia and personal fees from Mead Johnson, Abbott and Marfo Food Groups outside the submitted work. Professor Roberts reports he was Editor in Chief Clinical & Experimental Allergy until December 2020.
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