Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment,...

Area of Science:

• Allergy and Immunology
• Emergency Medicine

Background:

• Anaphylaxis is a severe, acute, and potentially life-threatening systemic allergic reaction.
• Biphasic anaphylaxis, characterized by symptom recurrence, can occur, with severe reactions and repeated epinephrine use being risk factors.

Purpose of the Study:

• To review the current understanding and management of anaphylaxis, focusing on biphasic reactions and pharmacotherapy.
• To evaluate the efficacy of various interventions in preventing biphasic anaphylaxis.

Main Methods:

• Literature review and synthesis of evidence regarding anaphylaxis management.
• Analysis of the role of epinephrine, antihistamines, and glucocorticoids in treating and preventing anaphylaxis and its biphasic course.

Main Results:

• Epinephrine is the established first-line treatment for both uniphasic and biphasic anaphylaxis.
• Antihistamines and glucocorticoids are not reliable for preventing biphasic anaphylaxis, though they may have roles in specific protocols like chemotherapy or immunotherapy.

Conclusions:

• Routine premedication with antihistamines or glucocorticoids is not supported for preventing radiocontrast media anaphylaxis.
• Post-treatment observation, patient education on triggers and self-injection, and allergist referral are crucial components of anaphylaxis care.