EAACI guidelines: Anaphylaxis (2021 update)

Antonella Muraro; Margitta Worm; Cherry Alviani; Victoria Cardona; Audrey DunnGalvin; Lene Heise Garvey; Carmen Riggioni; Debra de Silva; Elizabeth Angier; Stefania Arasi; Abdelouahab Bellou; Kirsten Beyer; Diola Bijlhout; Maria Beatrice Bilò; Carsten Bindslev-Jensen; Knut Brockow; Montserrat Fernandez-Rivas; Susanne Halken; Britt Jensen; Ekaterina Khaleva; Louise J. Michaelis; Hanneke N.G. Oude Elberink; Lynne Regent; Angel Sanchez; Berber J. Vlieg-Boerstra; Graham Roberts; European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group

doi:10.1111/all.15032

EAACI guidelines: Anaphylaxis (2021 update)

Antonella Muraro^*
, Margitta Worm
, Cherry Alviani
, Victoria Cardona
, Audrey DunnGalvin
, Lene Heise Garvey
, Carmen Riggioni
, Debra de Silva
, Elizabeth Angier
, Stefania Arasi
, Abdelouahab Bellou
, Kirsten Beyer
, Diola Bijlhout
, Maria Beatrice Bilò
, Carsten Bindslev-Jensen
, Knut Brockow
, Montserrat Fernandez-Rivas
, Susanne Halken
, Britt Jensen
, Ekaterina Khaleva

Louise J. Michaelis, Hanneke N.G. Oude Elberink, Lynne Regent, Angel Sanchez, Berber J. Vlieg-Boerstra, Graham Roberts, European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group

^*Corresponding author for this work

Padova University Hospital
Charité - University Medicine Berlin
University of Southampton
Vall d'Hebron University Hospital
University College Cork
Sechenov University
Copenhagen University Hospital
University of Copenhagen
Yong Loo Lin School of Medicine
The Evidence Centre, London.
Bambino Gesù Children’s Hospital
European Society for Emergency Medicine
Wayne State University
French National Institute of Health
Association for Teacher Education in Europe (ATEE)
Marche Polytechnic University
Azienda Ospedaliero-Universitaria Ospedali Riuniti
Complutense University of Madrid
Great North Children's Hospital
Newcastle University
University Medical Center Groningen
The Anaphylaxis Campaign
AEPNAA Spanish Association for People with Food and Latex Allergy
Our Lady's Guest House Hospital)
University Hospital Southampton NHS Foundation Trust
St. Mary's Hospital
Technical University of Munich

Research output: Contribution to journal › Journal article › Research › peer-review

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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.

Original language	English
Journal	Allergy
Volume	77
Issue number	2
Pages (from-to)	357-377
Number of pages	21
ISSN	0105-4538
DOIs	https://doi.org/10.1111/all.15032
Publication status	Published - Feb 2022

Funding

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.

Keywords

adults
anaphylaxis
children
guidelines

Documents & Links

10.1111/all.15032

Open Access VersionAccepted manuscript, 820 KB

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Muraro, A., Worm, M., Alviani, C., Cardona, V., DunnGalvin, A., Garvey, L. H., Riggioni, C., de Silva, D., Angier, E., Arasi, S., Bellou, A., Beyer, K., Bijlhout, D., Bilò, M. B., Bindslev-Jensen, C., Brockow, K., Fernandez-Rivas, M., Halken, S., Jensen, B., ... European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group (2022). EAACI guidelines: Anaphylaxis (2021 update). Allergy, 77(2), 357-377. https://doi.org/10.1111/all.15032

@article{8f877a232ffc4f0bb8bab7d09869f8da,

title = "EAACI guidelines: Anaphylaxis (2021 update)",

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.",

keywords = "adults, anaphylaxis, children, guidelines",

author = "Antonella Muraro and Margitta Worm and Cherry Alviani and Victoria Cardona and Audrey DunnGalvin and Garvey, \{Lene Heise\} and Carmen Riggioni and \{de Silva\}, Debra and Elizabeth Angier and Stefania Arasi and Abdelouahab Bellou and Kirsten Beyer and Diola Bijlhout and Bil{\`o}, \{Maria Beatrice\} and Carsten Bindslev-Jensen and Knut Brockow and Montserrat Fernandez-Rivas and Susanne Halken and Britt Jensen and Ekaterina Khaleva and Michaelis, \{Louise J.\} and \{Oude Elberink\}, \{Hanneke N.G.\} and Lynne Regent and Angel Sanchez and Vlieg-Boerstra, \{Berber J.\} and Graham Roberts and \{European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group\}",

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. ",

year = "2022",

month = feb,

doi = "10.1111/all.15032",

language = "English",

volume = "77",

pages = "357--377",

journal = "Allergy",

issn = "0105-4538",

publisher = "Wiley",

number = "2",

}

Muraro, A, Worm, M, Alviani, C, Cardona, V, DunnGalvin, A, Garvey, LH, Riggioni, C, de Silva, D, Angier, E, Arasi, S, Bellou, A, Beyer, K, Bijlhout, D, Bilò, MB, Bindslev-Jensen, C, Brockow, K, Fernandez-Rivas, M, Halken, S , Jensen, B, Khaleva, E, Michaelis, LJ, Oude Elberink, HNG, Regent, L, Sanchez, A, Vlieg-Boerstra, BJ, Roberts, G & European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group 2022, 'EAACI guidelines: Anaphylaxis (2021 update)', Allergy, vol. 77, no. 2, pp. 357-377. https://doi.org/10.1111/all.15032

TY - JOUR

T1 - EAACI guidelines

T2 - Anaphylaxis (2021 update)

AU - Muraro, Antonella

AU - Worm, Margitta

AU - Alviani, Cherry

AU - Cardona, Victoria

AU - DunnGalvin, Audrey

AU - Garvey, Lene Heise

AU - Riggioni, Carmen

AU - de Silva, Debra

AU - Angier, Elizabeth

AU - Arasi, Stefania

AU - Bellou, Abdelouahab

AU - Beyer, Kirsten

AU - Bijlhout, Diola

AU - Bilò, Maria Beatrice

AU - Bindslev-Jensen, Carsten

AU - Brockow, Knut

AU - Fernandez-Rivas, Montserrat

AU - Halken, Susanne

AU - Jensen, Britt

AU - Khaleva, Ekaterina

AU - Michaelis, Louise J.

AU - Oude Elberink, Hanneke N.G.

AU - Regent, Lynne

AU - Sanchez, Angel

AU - Vlieg-Boerstra, Berber J.

AU - Roberts, Graham

AU - European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group

N1 - 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.

PY - 2022/2

Y1 - 2022/2

N2 - 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.

AB - 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.

KW - adults

KW - anaphylaxis

KW - children

KW - guidelines

U2 - 10.1111/all.15032

DO - 10.1111/all.15032

M3 - Journal article

C2 - 34343358

AN - SCOPUS:85104918288

SN - 0105-4538

VL - 77

SP - 357

EP - 377

JO - Allergy

JF - Allergy

IS - 2

ER -

EAACI guidelines: Anaphylaxis (2021 update)

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