Management of anaphylaxis: a systematic review

Area of Science:

• Allergy and Immunology
• Emergency Medicine
• Pharmacology

Background:

• Anaphylaxis requires effective acute and long-term management strategies.
• Current evidence on interventions for anaphylaxis is being systematically evaluated.

Purpose of the Study:

• To establish the effectiveness of interventions for acute and long-term anaphylaxis management.
• To identify optimal treatment protocols and highlight gaps in the evidence base.

Main Methods:

• A systematic search of seven databases was conducted for various study designs, including systematic reviews and randomized controlled trials.
• Fifty-five studies met the inclusion criteria for evaluating anaphylaxis interventions.
• Specific focus on adrenaline (epinephrine) effectiveness and administration, alongside long-term management strategies.

Main Results:

• No robust studies were found for adrenaline, H1-antihistamines, systemic glucocorticosteroids, or methylxanthines in acute anaphylaxis management.
• Evidence suggests intramuscular adrenaline into the vastus lateralis muscle is the optimal administration route.
• Fatality data indicate that delayed or failed adrenaline administration increases mortality risk.
• Anaphylaxis management plans may reduce recurrent reactions, but studies are high risk for bias.
• Venom immunotherapy shows potential for reducing systemic reactions in venom-allergic individuals.

Conclusions:

• Intramuscular adrenaline is the recommended acute treatment for anaphylaxis, with timely administration crucial for survival.
• Anaphylaxis management plans and venom immunotherapy represent potential long-term strategies, though further high-quality research is needed.
• Significant gaps exist in the evidence for pharmacological interventions in acute anaphylaxis management.