World Allergy Organization anaphylaxis guidelines: Summary

Simons, F. Estelle R.; Ardusso, Ledit; Bilò, Maria Beatrice; El-Gamal, Yehia; Ledford, Dennis K.; Ring, Johannes; Sánchez‐Borges, Mario; Senna, Gianenrico; Sheikh, Aziz; Thong, Bernard Yu‐Hor

doi:10.1016/j.jaci.2011.01.038

Cited by 512 publications

(642 citation statements)

References 155 publications

(567 reference statements)

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“…In this study, we used the criteria of NIAID/FAAN and the case definition of Brighton Collaboration [10,11]. However, since these criteria correspond to the criteria for anaphylaxis recently suggested by the World Allergy Organization [17], our results would not have been altered if the latter criteria had been used. A considerable strength of this study is that we had access to the patients' record, including the Emergency Department record and the diagnostic allergy work-up, which led to the identification of the culprit food in over 85 % of cases.…”

Section: Resultsmentioning

confidence: 99%

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

et al. 2013

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There are wide differences in estimated incidence and prevalence of anaphylaxis because of the absence, until recently, of a universal consensus on the definition of anaphylaxis and the different source of collected data. We aimed to estimate the incidence of food anaphylaxis based on the database of Piemonte Region (Italy) Reference Center for Severe Allergic Reactions. All cases of severe food allergic reactions reported in 2010 were studied. Clinical data associated to the reports were evaluated according to National Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network diagnostic criteria of anaphylaxis. 75 % of the 778 cases were classified as food anaphylaxis (incidence of 13/100,000 personyears, ranging from 9.9 in adults to 29/100,000 person-years in children). Nuts were the most frequent foods causing anaphylaxis. Milk and eggs were responsible for anaphylaxis more often in children, while peach, vegetables and crustaceans were in adults. Cardiovascular symptoms were more frequent in adults. Gastrointestinal involvement was more frequent in children. A high prevalence of respiratory allergic comorbidities was observed. Food is an important cause of anaphylaxis, particularly in subjects with respiratory allergic comorbidities. Children and adults differ in triggers and clinical presentation of anaphylaxis.Keywords: Anaphylaxis, Food allergy, Epidemiology, Allergy Introduction Population-based studies estimate the incidence of anaphylaxis in western countries to be in the range of 4-50 per 100,000 person-years [1, 2], with a true lifetime prevalence in the range of 0.05-2 % [3]. Foods are reported to be the most important trigger of anaphylaxis, being responsible for 33.2-56 % of all anaphylaxis cases [4]. The other two principal triggers of anaphylaxis are insect stings and drugs [1,5]. The relative contribution of each of these triggers to anaphylaxis may differ according to the study design, study population, or geographic area. The wide differences in the estimated incidences and prevalences of anaphylaxis are the direct result of the absence, until recently, of a universal consensus on the definition of anaphylaxis and the different source of collected data. For this reason in 2005 the National Institute of Allergy and Infectious Disease (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) developed a very useful preliminary definition, based on diagnostic criteria [6]. The symposium defined anaphylaxis as: "a serious allergic reaction that is rapid in onset and may cause death". Clinically, involvement of at least two organs (skin or mucosal tissue, cardiovascular apparatus, breathing apparatus, gastrointestinal tract) is required, or a sudden reduced blood pressure along with a temporal relationship (generally minutes) to a potential causative agent. A problematic issue with this definition, which may explain the under-reporting or misreporting of anaphylaxis cases, is the failure to agree among health care providers on the severity threshold for classi...

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Section: Resultsmentioning

confidence: 99%

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

et al. 2013

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“…Most often, clinicians observed an association of infections and anaphylactic reactions following specific immunotherapy (SIT) with pollen or hymenoptera venoms. Although usually well tolerated, episodes of anaphylaxis occur after SIT in combination with infection and consequently patients undergoing SIT must not suffer from infections (5,11,57). In addition, the role of infections as cofactors of anaphylaxis is well documented in clinical trials with patients suffering from food allergy.…”

Section: Infections As Cofactors Of Anaphylaxismentioning

confidence: 99%

“…Meanwhile, physical exercise is the best studied cofactor of anaphylaxis and 'food-dependent exercise-induced anaphylaxis' (FDEIA) is accepted as a defined clinical entity. Other well-documented cofactors of anaphylaxis are nonsteroidal anti-inflammatory drugs (NSAID) like acetylsalicylic acid (ASA), alcohol consumption, and infectious diseases in general (5)(6)(7)(8)(9)(10)(11)(12). According to the anaphylaxis registries of different European countries, next to exercise, alcohol consumption is a relevant cofactor in up to 15.2% of anaphylactic events and drugs such as ASA were registered as a cofactor in 6.1-9% of severe anaphylactic reactions (Table 1).…”

mentioning

confidence: 99%

About the role and underlying mechanisms of cofactors in anaphylaxis

Wölbing

Fischer

Köberle

et al. 2013

Allergy

178

163

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Anaphylaxis is the systemic and most severe presentation of type I allergy. A number of conditions were identified that modulate the onset of anaphylaxis such as co-or augmentation factors, which significantly lower the allergen dose necessary for triggering anaphylaxis. Next to physical exercise or alcohol consumption, co-administration of nonsteroidal anti-inflammatory drugs (NSAID) or concomitant infectious diseases are well-documented cofactors of anaphylaxis. Registries for anaphylaxis document a role for cofactors in about 30% of anaphylactic reactions. Some disease entities such as 'wheat-dependent exercise-induced anaphylaxis' (WDEIA) are explicitly characterized by elicitation of anaphylaxis only in the presence of at least one such cofactor. Using WDEIA as a model disease, studies demonstrated that exercise increases skin prick test reactivity to and bioavailability of the allergen. Additional data indicate that alcohol consumption and NSAID administration display similar effects. Modulation of the cellular activation threshold is another mechanism underlying cofactor-induced anaphylaxis, most likely also functional when infectious diseases orchestrate elicitation of anaphylaxis. Cofactors are increasingly accepted to play a fundamental role in eliciting anaphylaxis. Consequently, to improve patient management modalities, a better understanding of the underlying mechanisms is warranted. This review aims to update clinicians and clinical scientists on recent developments.

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“…It can be life-saving (30), and delayed injection of adrenaline is associated with increased risk of fatality (8,31,32), as demonstrated in both insect sting-(31) and food-induced anaphylaxis (32). The World Allergy Organization (WAO) has consistently emphasized the need for prompt injection of adrenaline (33). The joint American Academy of Allergy, Asthma and Immunology (AAAAI) and American College of Allergy, Asthma and Immunology (ACAAI) guidelines (19) state that prompt recognition of the signs and symptoms of anaphylaxis with immediate treatment is crucial to reduce the severity of the systemic reaction, and that, if there is any doubt, it is generally better to administer adrenaline.…”

Section: Emergency Managementmentioning

confidence: 99%

Anaphylaxis treatment: current barriers to adrenaline auto-injector use

Song

Worm

Lieberman

2014

Allergy

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To cite this article: Song TT, Worm M, Lieberman P. Anaphylaxis treatment: current barriers to adrenaline auto-injector use. AbstractAnaphylaxis is a life-threatening condition that is increasing in prevalence in the developed world. There is universal expert agreement that rapid intramuscular injection of adrenaline is life-saving and constitutes the first-line treatment of anaphylaxis. The unpredictable nature of anaphylaxis and its rapid progression makes necessary the availability of a portable emergency treatment suitable for self-administration. Thus, anaphylaxis treatment guidelines recommend that at-risk patients are provided with adrenaline auto-injectors (AAIs). Despite these clear recommendations, current emergency treatment of anaphylaxis continues to be inadequate in many cases. The aim of this review is to highlight the barriers that exist to the use and availability of AAIs and that prevent proper management of anaphylaxis. In addition, we review the characteristics of all AAIs that are presently available in Europe and the USA and discuss the need for regulatory requirements to establish the performance characteristics of these devices.

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World Allergy Organization anaphylaxis guidelines: Summary

Cited by 512 publications

References 155 publications

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

About the role and underlying mechanisms of cofactors in anaphylaxis

Anaphylaxis treatment: current barriers to adrenaline auto-injector use

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