Diagnosing, managing and preventing anaphylaxis: Systematic review

Area of Science:

• Allergy and Clinical Immunology
• Emergency Medicine

Background:

• Anaphylaxis is a severe, life-threatening allergic reaction.
• Robust evidence for diagnosis and management is lacking due to practical and ethical challenges.

Purpose of the Study:

• To systematically review and compile evidence for the European Academy of Allergy and Clinical Immunology (EAACI) anaphylaxis guideline.
• To inform clinical practice regarding anaphylaxis diagnosis, management, and prevention.

Main Methods:

• Systematic review utilizing the GRADE approach.
• Searched five bibliographic databases (1946–2020) for studies on anaphylaxis.
• Included 50 studies (29 RCTs, 7 CCTs, 7 case series, 7 case-control studies); narrative synthesis due to heterogeneity.

Main Results:

• Low certainty evidence exists for diagnostic criteria (NIAID/FAAN, Brighton).
• Limited evidence on most management and prevention strategies; adrenaline use is common but under-researched.
• Adrenaline autoinjectors and layperson training may offer slight improvements in use and knowledge.

Conclusions:

• Significant evidence gaps hinder optimal anaphylaxis diagnosis and management.
• Further high-quality research is crucial to improve patient outcomes for anaphylaxis.