The diagnosis and management of anaphylaxis: An updated practice parameter - 18/08/11

Doi : 10.1016/j.jaci.2005.01.010

Phillip Lieberman, Chief Editors:MD, Stephen F. Kemp, MD, John Oppenheimer, MD, David M. Lang, MD, I. Leonard Bernstein, MD, Richard A. Nicklas, MD ^{^{This parameter was edited by Dr Nicklas in his private capacity and not in his capacity as a medical officer with the Food and Drug Administration. No official support or endorsement by the Food and Drug Administration is intended or should be inferred.}}

John A. Anderson, Workgroup Contributors:MD, David I. Bernstein, MD, Jonathan A. Bernstein, MD, Jordan N. Fink, MD, Paul A. Greenberger, MD, Dennis K. Ledford, MD, James Li, MD, PhD, Albert L. Sheffer, MD, Roland Solensky, MD, Bruce L. Wolf, MD

Joann Blessing-Moore, Task Force Reviewers:MD, David A. Khan, MD, Rufus E. Lee, MD, Jay M. Portnoy, MD, Diane E. Schuller, MD, Sheldon L. Spector, MD, Stephen A. Tilles, MD

Abstract

These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.

The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing “The diagnosis and management of anaphylaxis: an updated practice parameter.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.

This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients.

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Plan

Contributors

Chief editors

Workgroup contributors

Task force reviewers

Reviewers

Classification of recommendations and evidence

Category of evidence

Strength of recommendation

Preface

Algorithm for initial evaluation and management of a patient with a history of anaphylaxis ()

Annotation 1: Is the history consistent with a previous episode of anaphylaxis?

Annotation 1A: Consider consultation with an allergist-immunologist

Annotation 2: Pursue other diagnoses or make appropriate referral

Annotation 3: Is cause readily identified by history?

Annotation 4: Consider idiopathic anaphylaxis

Annotation 5: Are further diagnostic tests indicated: immediate hypersensitivity or in vitro tests, challenge tests?

Annotation 6: Diagnosis established on basis of history, risk of testing, limitation of tests, patient refuses test, other management options available, management

Annotation 7: Testing identifies specific cause of anaphylaxis

Annotation 8: Reconsider clinical diagnosis, reconsider idiopathic anaphylaxis, consider other triggers, consider further testing, management

Annotation 9: Diagnosis made of specific cause of anaphylaxis

Annotation 10: Management of anaphylaxis

Algorithm for the treatment of acute anaphylaxis ()

Annotation 1. Anaphylaxis preparedness

Annotation 2. Patient presents with possible-probable acute anaphylaxis

Annotation 3. Initial assessment supports potential anaphylaxis

Annotation 4. Consider other diagnosis

Annotation 5. Immediate intervention

Annotation 6. Subsequent emergency care that might be necessary depending on response to epinephrine

Annotation 7. Cardiopulmonary arrest during anaphylaxis

Annotation 8. Observation and subsequent follow-up

Annotation 9. Consider consultation with an allergist-immunologist

Summary statements

Evaluation and management of the patient with a history of episodes of anaphylaxis

Management of anaphylaxis

Latex-induced anaphylaxis

Anaphylaxis during general anesthesia, the intraoperative period, and the postoperative period

Seminal fluid-induced anaphylaxis

Exercise-induced anaphylaxis

Idiopathic anaphylaxis

Anaphylaxis and allergen immunotherapy vaccines

Anaphylaxis to drugs

Prevention of anaphylaxis

Evaluation and management of the patient with a history of episodes of anaphylaxis

Summary statements

Performing the history

Differential diagnosis

Laboratory studies

Management of anaphylaxis

Summary statements

Signs and symptoms of anaphylaxis

Differential diagnosis in anaphylaxis

Management of anaphylaxis

Analysis of anaphylaxis outcomes and procedures

Guide to physician-supervised management of anaphylaxis

Latex-induced anaphylaxis

Anaphylaxis during general anesthesia, the intraoperative period, and the postoperative period

Summary statements

Local anesthetics

Seminal fluid–induced anaphylaxis

Summary statements

Diagnosis

Treatment

Exercise-induced anaphylaxis

Summary statements

Idiopathic anaphylaxis

Summary statements

Anaphylaxis and allergen immunotherapy vaccines

Prevention of anaphylaxis

Summary statements

Disclosure of potential conflict of interest: P. Lieberman—none disclosed. S. F. Kemp has consultant arrangements with MedPointe Pharmaceuticals. J. Oppenheimer—none disclosed. D. M. Lang—none disclosed. I. L. Bernstein—none disclosed. R. A. Nicklas—none disclosed. J. A. Anderson—none disclosed. D. I. Bernstein—none disclosed. J. Bernstein is on the Speakers' Bureau for Merck, GlaxoSmithKline, AstraZeneca, Aventis, Medpointe, Pfizer, Schering-Plough, and IVAX. J. N. Fink—none disclosed. P. A. Greenberger—none disclosed. D. K. Ledford—none disclosed. J. Li—none disclosed. A. L. Sheffer—none disclosed. R. Solensky—none disclosed. B. L. Wolf—none disclosed. J. Blessing-Moore—none disclosed. D. A. Khan has consultant arrangements with Pfizer; receives grants/research support from AstraZeneca; and is on the Speakers' Bureau for Pfizer, Merck, Aventis, and GlaxoSmithKline. R. E. Lee—none disclosed. J. M. Portnoy—none disclosed. D. E. Schuller is on the Speakers' Bureau for Boehringer-Ingelheim. S.L. Spector has had consultant arrangements with, has received grants/research support from, and has been on the Speakers' Bureau for Abbott, Allen & Hanburys, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Fisons, Forest, ICN, Key, Eli-Lilly, 3M, Miles, Muro, Pfizer, Purdue Frederick, Schering-Plough, Wallace, and Witby. S. A. Tilles—none disclosed.
Reprint requests: Joint Council of Allergy, Asthma & Immunology, 50 N Brockway St, #3-3, Palatine, IL 60067.

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Vol 115 - N° 3S2

P. S483-S523 - mars 2005 Retour au numéro

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The diagnosis and management of anaphylaxis: An updated practice parameter
Phillip Lieberman, Stephen F. Kemp, John Oppenheimer, David M. Lang, I. Leonard Bernstein, Richard A. Nicklas, John A. Anderson, David I. Bernstein, Jonathan A. Bernstein, Jordan N. Fink, Paul A. Greenberger, Dennis K. Ledford, James Li, Albert L. Sheffer, Roland Solensky, Bruce L. Wolf, Joann Blessing-Moore, David A. Khan, Rufus E. Lee, Jay M. Portnoy, Diane E. Schuller, Sheldon L. Spector, Stephen A. Tilles

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The diagnosis and management of anaphylaxis: An updated practice parameter - 18/08/11

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