Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Sampson, Hugh A.; Muñoz-Furlong, Anne; Campbell, Ronna L.; Adkinson, N. Franklin; Bock, S. Allan; Branum, Amy M.; Brown, Simon G A; Camargo, Carlos A.; Cydulka, Rita K.; Galli, Stephen J.; Gidudu, Jane; Gruchalla, Rebecca S.; Harlor, Allen D. “Buz”; Hepner, David L.; Lewis, Lawrence M.; Lieberman, Phillip; Metcalfe, Dean D.; O’Connor, Robert E.; Muraro, Antonella; Rudman, A. R.; Schmitt, Cara; Scherrer, Debra; Simons, F. E. R.; Thomas, Stephen R.; Wood, Joseph P.; Decker, Wyatt W.

doi:10.1016/j.jaci.2005.12.1303

Cited by 1,931 publications

(1,238 citation statements)

References 45 publications

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“…The first line of evidence for diagnosing anaphylaxis includes clinical signs. Although no set of diagnostic criteria for anaphylaxis has 100% sensitivity or specificity, the clinical criteria for diagnosing anaphylaxis proposed by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network have been widely used in many countries 1. Anaphylaxis is considered likely if any one of three stipulated criteria is satisfied (Table 2).…”

Section: Diagnosismentioning

confidence: 99%

“…4). 1, 31, 32, 33 Early injection of adrenaline for anaphylaxis, defined as injection before ER arrival, can significantly reduce the likelihood of hospital admission, as compared with initial injection after arrival at the ER 34. Although no human studies regarding the timing of treatment for anaphylaxis could be found, analysis of 92 deaths related to anaphylaxis showed that adrenaline was given prior to cardiac arrest in only 22 of the cases (24%) 35.…”

Section: Initial Treatment Of Anaphylaxismentioning

confidence: 99%

“…Most international anaphylaxis guidelines recommend injection of adrenaline by the intramuscular route in the mid‐anterolateral thigh at a dose of 0.01 mg/kg of a 1:1,000 (1 mg/mL) solution, up to a maximum of 0.5 mg in adults (0.3 mg in children). Depending on the severity of the episode and the response to the initial injection, the dose can be repeated every 5–15 min, as required 1, 31, 33, 36. Intravenous adrenaline is an option in patients with severe hypotension or cardiac arrest unresponsive to intramuscular doses of adrenaline and fluid resuscitation 1.…”

Section: Initial Treatment Of Anaphylaxismentioning

confidence: 99%

“…Depending on the severity of the episode and the response to the initial injection, the dose can be repeated every 5–15 min, as required 1, 31, 33, 36. Intravenous adrenaline is an option in patients with severe hypotension or cardiac arrest unresponsive to intramuscular doses of adrenaline and fluid resuscitation 1. Despite these therapeutic benefits of adrenaline and the recommendations for its use, adrenaline injection rates remain low in many ERs37, 38 (Fig.…”

Section: Initial Treatment Of Anaphylaxismentioning

confidence: 99%

“…Anaphylaxis is defined as a serious allergic reaction with a rapid onset, which can be fatal 1. In an emergency room (ER) setting, it is usually difficult for physicians to correctly diagnose anaphylaxis because of its broad and often atypical presentation.…”

Section: Introductionmentioning

confidence: 99%

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Drug‐induced anaphylaxis in the emergency room

Takazawa

Oshima

Saito

2017

Acute Medicine & Surgery

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Anaphylaxis is a life‐threatening, systemic allergic reaction that presents unique challenges for emergency care practitioners. Anaphylaxis occurs more frequently than previously believed. Therefore, proper knowledge regarding the epidemiology, mechanisms, symptoms, diagnosis, and treatment of anaphylaxis is essential. In particular, the initial treatment strategy, followed by correct diagnosis, in the emergency room is critical for preventing fatal anaphylaxis, although making a diagnosis is not easy because of the broad and often atypical presentation of anaphylaxis. To this end, the clinical criteria proposed by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network are useful, which, together with a differential diagnosis, could enable a more accurate diagnosis. Additional in vitro tests, such as plasma histamine and tryptase measurements, are also helpful. It should be emphasized that adrenaline is the only drug recommended as first‐line therapy in all published national anaphylaxis guidelines. Most international anaphylaxis guidelines recommend injecting adrenaline by the intramuscular route in the mid‐anterolateral thigh, whereas i.v. adrenaline is an option for patients with severe hypotension or cardiac arrest unresponsive to intramuscular adrenaline and fluid resuscitation. In addition to the route of administration, choosing the appropriate dose of adrenaline is essential, because serious adverse effects can potentially occur after an overdose of adrenaline. Furthermore, to avoid future recurrence of anaphylaxis, providing adrenaline auto‐injectors and making an etiological diagnosis, including confirmation of the offending trigger, are recommended for patients at risk of anaphylaxis before their discharge from the emergency room.

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Section: Diagnosismentioning

confidence: 99%

Section: Initial Treatment Of Anaphylaxismentioning

confidence: 99%

Section: Initial Treatment Of Anaphylaxismentioning

confidence: 99%

Section: Initial Treatment Of Anaphylaxismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Drug‐induced anaphylaxis in the emergency room

Takazawa

Oshima

Saito

2017

Acute Medicine & Surgery

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Comparative Risk of Anaphylactic Reactions Associated With Intravenous Iron Products

Wang

Graham

Kane

et al. 2015

JAMA

191

165

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Effect of Epicutaneous Immunotherapy vs Placebo on Reaction to Peanut Protein Ingestion Among Children With Peanut Allergy

Fleischer

Greenhawt

Sussman³

et al. 2019

JAMA

224

182

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IMPORTANCE There are currently no approved treatments for peanut allergy. OBJECTIVE To assess the efficacy and adverse events of epicutaneous immunotherapy with a peanut patch among peanut-allergic children. DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, double-blind, placebo-controlled trial conducted at 31 sites in 5 countries between January 8, 2016, and August 18, 2017. Participants included peanut-allergic children (aged 4-11 years [n = 356] without a history of a severe anaphylactic reaction) developing objective symptoms during a double-blind, placebo-controlled food challenge at an eliciting dose of 300 mg or less of peanut protein. INTERVENTIONS Daily treatment with peanut patch containing either 250 μg of peanut protein (n = 238) or placebo (n = 118) for 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was the percentage difference in responders between the peanut patch and placebo patch based on eliciting dose (highest dose at which objective signs/symptoms of an immediate hypersensitivity reaction developed) determined by food challenges at baseline and month 12. Participants with baseline eliciting dose of10mgorlesswererespondersiftheposttreatmentelicitingdosewas300mgormore;participants with baseline eliciting dose greater than 10 to 300 mg were responders if the posttreatment eliciting dose was 1000 mg or more. A threshold of 15% or more on the lower bound of a 95% CI around responder rate difference was prespecified to determine a positive trial result. Adverse event evaluation included collection of treatment-emergent adverse events (TEAEs). RESULTS Among 356 participants randomized (median age, 7 years; 61.2% male), 89.9% completed the trial; the mean treatment adherence was 98.5%. The responder rate was 35.3% with peanut-patch treatment vs 13.6% with placebo (difference, 21.7% [95% CI, 12.4%-29.8%; P < .001]). The prespecified lower bound of the CI threshold was not met. TEAEs, primarily patch application site reactions, occurred in 95.4% and 89% of active and placebo groups, respectively. The all-causes rate of discontinuation was 10.5% in the peanut-patch group vs 9.3% in the placebo group. CONCLUSIONS AND RELEVANCE Among peanut-allergic children aged 4 to 11 years, the percentage difference in responders at 12 months with the 250-μg peanut-patch therapy vs placebo was 21.7% and was statistically significant, but did not meet the prespecified lower bound of the confidence interval criterion for a positive trial result. The clinical relevance of not meeting this lower bound of the confidence interval with respect to the treatment of peanut-allergic children with epicutaneous immunotherapy remains to be determined.

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Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Cited by 1,931 publications

References 45 publications

Drug‐induced anaphylaxis in the emergency room

Drug‐induced anaphylaxis in the emergency room

Comparative Risk of Anaphylactic Reactions Associated With Intravenous Iron Products

Effect of Epicutaneous Immunotherapy vs Placebo on Reaction to Peanut Protein Ingestion Among Children With Peanut Allergy

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