Anaphylaxis: A 2023 practice parameter update

Golden, David B.K.; Wang, Julie; Waserman, Susan; Akin, Cem; Campbell, Ronna L.; Ellis, Anne K.; Greenhawt, Matthew; Lang, David M.; Ledford, Dennis K.; Lieberman, Jay; Oppenheimer, John; Shaker, Marcus S.; Wallace, Dana V.; Abrams, Elissa M.; Bernstein, Jonathan A.; Chu, Derek K.; Horner, Caroline C.; Rank, Matthew A.; Stukus, David R.; Burrows, Alyssa G.; Cruickshank, Heather; Golden, David B.K.; Wang, Julie; Akin, Cem; Campbell, Ronna L.; Ellis, Anne K.; Greenhawt, Matthew; Lang, David M.; Ledford, Dennis K.; Lieberman, Jay; Oppenheimer, John; Shaker, Marcus S.; Wallace, Dana V.; Waserman, Susan; Abrams, Elissa M.; Bernstein, Jonathan A.; Chu, Derek K.; Ellis, Anne K.; Golden, David B.K.; Greenhawt, Matthew; Horner, Caroline C.; Ledford, Dennis K.; Lieberman, Jay; Rank, Matthew A.; Shaker, Marcus S.; Stukus, David R.; Wang, Julie

doi:10.1016/j.anai.2023.09.015

Cited by 76 publications

(8 citation statements)

References 453 publications

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“…Therefore, the use of concomitant nonselective beta-blockers like propranolol is a relative contraindication to AIT 86,92 with shared decision-making (regarding the potential risk of a more severe reaction) playing an important role when considering AIT with concomitant beta-blocker use. 93…”

Section: Clinicians May Choose Not To Initiate Immunotherapy For Pati...mentioning

confidence: 99%

“…Therefore, a history of anaphylaxis is a relative contraindication to AIT with shared decision-making (regarding the potential risk of a more severe reaction) playing an important role when considering AIT in a patient who has had a history of anaphylaxis. 83,86,90,93…”

Section: Clinicians May Choose Not To Initiate Immunotherapy For Pati...mentioning

confidence: 99%

“…Anaphylaxis is a systemic, potentially life-threatening syndrome typically with multiorgan involvement. 93 The signs and symptoms of anaphylaxis can vary from mild to severe, including hives, swelling, itching, respiratory distress, chest pain, abdominal pain, and hypotension. The most severe form of anaphylaxis can lead to cardiovascular collapse and death.…”

Section: Supporting Textmentioning

confidence: 99%

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Clinical Practice Guideline: Immunotherapy for Inhalant Allergy

Gurgel,

Baroody,

Damask

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveAllergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AIT is administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence‐based recommendations for improved patient care.PurposeThe purpose of this clinical practice guideline (CPG) is to identify quality improvement opportunities and provide clinicians trustworthy, evidence‐based recommendations regarding the management of inhaled allergies with immunotherapy. Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce the risk of harm. The target patients for the guideline are any individuals aged 5 years and older with AR, with or without AA, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The target audience is all clinicians involved in the administration of immunotherapy. This guideline is intended to focus on evidence‐based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of inhaled allergies with immunotherapy. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients.Action StatementsThe GDG made a strong recommendation that (Key Action Statement [KAS] 10) the clinician performing allergy skin testing or administering AIT must be able to diagnose and manage anaphylaxis. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with AR with or without AA if their patients' symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (KAS 2A) Clinicians should not initiate AIT for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (KAS 3) Clinicians should evaluate the patient or refer the patient to a clinician who can evaluate for signs and symptoms of asthma before initiating AIT and for signs and symptoms of uncontrolled asthma before administering subsequent AIT. (KAS 4) Clinicians should educate patients who are immunotherapy candidates regarding the differences between SCIT and SLIT (aqueous and tablet) including risks, benefits, convenience, and costs. (KAS 5) Clinicians should educate patients about the potential benefits of AIT in (1) preventing new allergen sensitizations, (2) reducing the risk of developing AA, and (3) altering the natural history of the disease with continued benefit after discontinuation of therapy. (KAS 6) Clinicians who administer SLIT to patients with seasonal AR should offer pre‐ and co‐seasonal immunotherapy. (KAS 7) Clinicians prescribing AIT should limit treatment to only those clinically relevant allergens that correlate with the patient's history and are confirmed by testing. (KAS 9) Clinicians administering AIT should continue escalation or maintenance dosing when patients have local reactions (LRs) to AIT. (KAS 11) Clinicians should avoid repeat allergy testing as an assessment of the efficacy of ongoing AIT unless there is a change in environmental exposures or a loss of control of symptoms. (KAS 12) For patients who are experiencing symptomatic control from AIT, clinicians should treat for a minimum duration of 3 years, with ongoing treatment duration based on patient response to treatment. The GDG offered the following KASs as options: (KAS 2B) Clinicians may choose not to initiate AIT for patients who use concomitant beta‐blockers, have a history of anaphylaxis, have systemic immunosuppression, or have eosinophilic esophagitis (SLIT only). (KAS 8) Clinicians may treat polysensitized patients with a limited number of allergens.

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Section: Clinicians May Choose Not To Initiate Immunotherapy For Pati...mentioning

confidence: 99%

Section: Clinicians May Choose Not To Initiate Immunotherapy For Pati...mentioning

confidence: 99%

Section: Supporting Textmentioning

confidence: 99%

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Clinical Practice Guideline: Immunotherapy for Inhalant Allergy

Gurgel,

Baroody,

Damask

et al. 2024

Otolaryngol.--head neck surg.

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“…Anaphylaxis most often occurs in response to food, insect stings, and drugs but can also be exercise-induced or idiopathic. Because anaphylaxis can occur outside the home, patients should be counseled on allergen avoidance and the importance of having epinephrine available [ 12 ]. Effective symptom resolution, in part, depends on the immediate administration of epinephrine by a patient or caregiver [ 29 ].…”

Section: Neffy Product Informationmentioning

confidence: 99%

“…The vast majority of severe Type I allergic reactions occur in out-of-hospital settings, and the immediate administration of epinephrine is the only universally recommended first-line treatment [ 10 , 11 , 12 ]. Antihistamine and corticosteroid agents are considered second-line treatment for anaphylaxis, given their slow onset of action and inability to stabilize or prevent mast cell degranulation or to target additional mediators of anaphylaxis, which is the essential physiologic effects of epinephrine [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Development of neffy, an Epinephrine Nasal Spray, for Severe Allergic Reactions

Ellis,

Casale,

Kaliner

et al. 2024

Pharmaceutics

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Epinephrine autoinjectors (EAIs) are used for the treatment of severe allergic reactions in a community setting; however, their utility is limited by low prescription fulfillment rates, failure to carry, and failure to use due to fear of needles. Given that delayed administration of epinephrine is associated with increased morbidity/mortality, there has been a growing interest in developing needle-free, easy-to-use delivery devices. neffy (epinephrine nasal spray) consists of three Food and Drug Administration (FDA)-approved components: epinephrine, Intravail A3 (absorption enhancer), and a Unit Dose Spray (UDS). neffy’s development pathway was established in conjunction with the FDA and the European Medicines Agency and included multiple clinical trials to evaluate pharmacokinetic and pharmacodynamic responses under a variety of conditions, such as self-administration and allergic and infectious rhinitis, as well as an animal anaphylaxis model of severe hypotension, where neffy demonstrated a pharmacokinetic profile that is within the range of approved injection products and a pharmacodynamic response that is as good or better than injections. The increased pulse rate (PR) and blood pressure (BP) observed even one minute following the administration of neffy confirm the activation of α and β adrenergic receptors, which are the key components of epinephrine’s mechanism of action. The results suggest that neffy will provide a safe and effective needle-free option for the treatment of severe allergic reactions, including anaphylaxis.

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10 practical priorities to prevent and manage serious allergic reactions: GA²LEN ANACare and EFA Anaphylaxis Manifesto

Muraro,

de Silva,

Podesta

et al. 2024

Clinical & Translational All

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This Anaphylaxis Manifesto calls on communities to prioritise 10 practical actions to improve the lives of people at risk of serious allergic reactions. The Global Allergy and Asthma European Network and the European Federation of Allergy and Airways Diseases Patients' Associations (EFA) compiled patient‐centric priorities. We used qualitative consensus methods, research evidence and feedback from over 200 patient groups, stakeholder organisations and healthcare professionals. We encourage healthcare, education and food organisations to collaborate with people at risk of serious allergic reactions to tackle safety, anxiety and financial burdens for individuals and societies. Key priorities for prevention include awareness‐raising campaigns for the public and professionals, school and workplace initiatives and mandatory precautionary allergen labels on food. Priorities for improving immediate and long‐term management include educating healthcare professionals, patients and schools about when and how to use adrenaline, funding two approved adrenaline devices for everyone at risk, and facilitating access to allergy specialists. Integrated care pathways should include clinical and non‐clinical management options such as individualised risk assessment and quality of life assessment, self‐management plans, dietetic and psychosocial support and peer support. Organisations around the world are committing to work together towards these priorities.

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Anaphylaxis: A 2023 practice parameter update

Cited by 76 publications

References 453 publications

Clinical Practice Guideline: Immunotherapy for Inhalant Allergy

Clinical Practice Guideline: Immunotherapy for Inhalant Allergy

Development of neffy, an Epinephrine Nasal Spray, for Severe Allergic Reactions

10 practical priorities to prevent and manage serious allergic reactions: GA²LEN ANACare and EFA Anaphylaxis Manifesto

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Anaphylaxis: A 2023 practice parameter update

Cited by 76 publications

References 453 publications

Clinical Practice Guideline: Immunotherapy for Inhalant Allergy

Clinical Practice Guideline: Immunotherapy for Inhalant Allergy

Development of neffy, an Epinephrine Nasal Spray, for Severe Allergic Reactions

10 practical priorities to prevent and manage serious allergic reactions: GA2LEN ANACare and EFA Anaphylaxis Manifesto

Contact Info

Product

Resources

About

10 practical priorities to prevent and manage serious allergic reactions: GA²LEN ANACare and EFA Anaphylaxis Manifesto