International consensus on (ICON) anaphylaxis

Abstract

ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction.They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice.For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences.ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available.ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research.In addition to confirming the alignment of major anaphylaxis guidelines, ICON: Anaphylaxis adds value by including summary tables and citing 130 key references. It is published as an information resource about anaphylaxis for worldwide use by healthcare professionals, academics, policy-makers, patients, caregivers, and the public.

Triggers, risk factors and clinico‐pathological features of urticaria in dogs – a prospective observational study of 24 cases

“…57 In humans, an observation period of 6-8 h for patients with respiratory symptoms and 12-24 h for patients with hypotension and collapse is recommended due to possible biphasic reactions, but should be assessed on a case-by-case basis. 11,12 An anaphylaxis veterinary review recommended 3 days, but this was not based on clinical data from studies. 37 In our study, dogs with anaphylaxis were hospitalized for 1.5 days on average and no biphasic reactions were observed, as reported previously.…”

“…11 Clinical criteria for anaphylaxis were adapted from human medicine. 8,11,12,21,39 A dog was diagnosed with anaphylaxis if, in addition to urticaria, there were signs of systemic involvement:…”

“…Anaphylaxis is a serious, generalized or systemic, allergic or hypersensitivity reaction with sudden onset (minutes to a few hours) that can be life threatening or even fatal. [8][9][10][11][12] The target organs in humans often include the respiratory tract (70% of episodes) and less frequently the gastrointestinal (GI) organs (30-45% of episodes), heart and vasculature (10-45% of episodes) and central nervous system (CNS) (10-15% of episodes). 8 It is generally agreed that anaphylaxis may occur with or without cutaneous signs, even though these latter signs are frequent and occur in 80-100% of cases.…”

The role and choice criteria of antihistamines in allergy management – Expert opinion

“…Antihistamines blocking H1 and/or H2 receptors are not the drugs of choice in anaphylaxis, and should not be used in monotherapy [73]. The antihistamines could be helpful in management of children with anaphylaxis as a second or third treatment line [74].…”

The moral life of epinephrine in the United States

“…These devices are about the size of a marker and consist of a needle, a dose of medication, and a protective plastic case that covers the medication and the needle before and after use. Both global and regional/country-specific medical guidelines throughout the world tell physicians that prompt use of epinephrine is the primary method for reducing the risk of serious injury, such as brain damage, or death resulting from anaphylaxis (Simons et al 2014). As a result, food allergy patients in the United States are counseled by their physicians to keep two auto-injector devices on their person at all times.…”