Knowledge gaps in the diagnosis and management of anaphylaxis

Knowledge gaps in the diagnosis and treatment of anaphylaxis impede the clinician's ability to effectively manage patients with anaphylaxis. This review will emphasize the lack of a global consensus on defining and determining the severity of anaphylaxis; the need for validating biomarkers used for diagnosing anaphylaxis; and data collection deficiencies. Perioperative anaphylaxis has a wide differential diagnosis, often requires treatment beyond epinephrine, and poses a challenge for the clinician in identifying the responsible trigger(s) and in preventing future reactions. Consensus-derived definitions and determination of risk factors for biphasic, refractory, and persistent anaphylaxis are needed, recognizing that these often affect the emergency department observation time after recovery from initial anaphylaxis. Knowledge gaps exist in the use of epinephrine, including route of administration, dosage, needle length, and ideal timing for administration. Consensus is needed on when and how many epinephrine autoinjectors to prescribe and how to prevent patient underuse and accidental injury. The role of antihistamines and corticosteroids in the prevention and treatment of anaphylaxis requires consensus and additional research. A consensus-derived algorithm for management of idiopathic anaphylaxis is needed. The role of beta-blockers and angiotensin-converting enzyme inhibitors in the incidence, severity, and treatment of anaphylaxis remains unanswered. Rapid recognition and treatment of anaphylaxis in the community needs improvement. The article will conclude with exploring the recommended components of both a patient-specific and generic anaphylaxis emergency plan, including when to activate emergency medical services, all of which are paramount to improving patient outcomes.