Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:145

Review

Shaker, Marcus S.¹  Wallace, Dana V.²  Golden, David B. K.³  Oppenheimer, John^4,5  Bernstein, Jonathan A.⁶  Campbell, Ronna L.⁷  Dinakar, Chitra⁸  Ellis, Anne⁹  Greenhawt, Matthew¹⁰  Khan, David A.¹¹  Lang, David M.¹²  Lang, Eddy S.¹³  Lieberman, Jay A.¹⁴  Portnoy, Jay¹⁵  Rank, Matthew A.¹⁶  Stukus, David R.^17,18  Wang, Julie¹⁹  Riblet, Natalie²⁰  Bobrownicki, Aiyana M. P.²⁰  Bontrager, Teresa²¹  Dusin, Jarrod²¹  Foley, Jennifer²¹  Frederick, Becky²¹  Fregene, Eyitemi²⁰  Hellerstedt, Sage²⁰  Hassan, Ferdaus²¹  Hess, Kori²¹  Huntington, Kelly²¹  Kasireddy, Poojita²⁰  Keeler, David²¹  Kim, Bertha²⁰  Lieberman, Phil¹⁴  Lindhorst, Erin²¹  McEnany, Fiona²⁰  Milbank, Jennifer²⁰  Murphy, Helen²¹  Pando, Oriana²⁰  Patel, Ami K.²⁰  Ratliff, Nicole²¹  Rhodes, Robert²¹  Robertson, Kim²¹  Scott, Hope²¹  Snell, Audrey²¹  Sullivan, Rhonda²¹  Trivedi, Varahi²⁰  Wickham, Azadeh²¹ 

[1] Geisel Sch Med Dartmouth, Dartmouth Hitchcock Med Ctr, Sect Allergy & Clin Immunol, Lebanon, NH USA

[2] Nova Southeastern Allopath Med Sch, Ft Lauderdale, FL USA

[3] Johns Hopkins Univ, Div Allergy Clin Immunol, Baltimore, MD USA

[4] Univ Med & Dent New Jersey, Rutgers New Jersey Med Sch, Dept Internal Med Pulm & Allergy, Morristown, NJ USA

[5] Pulm & Allergy Associates, Morristown, NJ USA

[6] Univ Cincinnati, Coll Med, Dept Internal Med, Div Immunol,Allergy Sect, Cincinnati, OH 45221 USA

[7] Mayo Clin, Dept Emergency Med, Rochester, MN USA

[8] Stanford Univ, Sch Med, Div Pulm Allergy & Crit Care Med, Allergy Asthma & Immunodeficiency, Stanford, CA 94305 USA

[9] Queens Univ, Dept Med, Div Allergy & Immunol, Kingston, ON, Canada

[10] Univ Colorado, Sch Med, Childrens Hosp Colorado, Sect Allergy & Immunol, Denver, CO USA

[11] Univ Texas Southwestern Med Ctr Dallas, Dept Internal Med, Div Allergy & Immunol, Dallas, TX USA

[12] Cleveland Clin, Dept Allergy & Clin Immunol, Resp Inst, Cleveland, OH 44106 USA

[13] Univ Calgary, Cumming Sch Med, Dept Emergency Med, Calgary, AB, Canada

[14] Univ Tennessee, Hlth Sci Ctr, Dept Pediat, Memphis, TN USA

[15] Childrens Mercy Hosp, Kansas City Sch Med, Pediat Allergy & Immunol, Kansas City, MO 64108 USA

[16] Mayo Clin, Div Allergy Asthma & Clin Immunol, Scottsdale, AZ USA

[17] Nationwide Childrens Hosp, Div Allergy & Immunol, Columbus, OH USA

[18] Ohio State Univ, Coll Med, Columbus, OH 43210 USA

[19] Icahn Sch Med Mt Sinai, Div Allergy & Immunol, New York, NY 10029 USA

[20] Dartmouth Inst Hlth Policy & Clin Practice, Hanover, NH USA

[21] Childrens Mercy Hosp, Off Evidence Based Practice, Kansas City, MO USA

关键词: Anaphylaxis;    GRADE;    epinephrine;    risk factors;    biphasic;    severity;    glucocorticoids;    antihistamines;    pretreatment-radiocontrast media;    chemotherapy;    mAb;    infliximab;    allergen immunotherapy;    systematic meta-analysis;    evidence to recommendations;    guideline;    practice parameter;   

DOI  :  10.1016/j.jaci.2020.01.017

来源: Elsevier

【 摘 要 】

Anaphylaxis is an acute, potential life-threatening systemic allergic reaction that may have a wide range of clinical manifestations. Severe anaphylaxis and/or the need for repeated doses of epinephrine to treat anaphylaxis are risk factors for biphasic anaphylaxis. Antihistamines and/or glucocorticoids are not reliable interventions to prevent biphasic anaphylaxis, although evidence supports a role for antihistamine and/or glucocorticoid premedication in specific chemotherapy protocols and rush aeroallergen immunotherapy. Evidence is lacking to support the role of antihistamines and/or glucocorticoid routine premedication in patients receiving low- or iso-osmolar contrast material to prevent recurrent radiocontrast media anaphylaxis. Epinephrine is the first-line pharmacotherapy for uniphasic and/or biphasic anaphylaxis. After diagnosis and treatment of anaphylaxis, all patients should be kept under observation until symptoms have fully resolved. All patients with anaphylaxis should receive education on anaphylaxis and risk of recurrence, trigger avoidance, self-injectable epinephrine education, referral to an allergist, and be educated about thresholds for further care.

【 授权许可】

Free