Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis - 06/04/20
Doi : 10.1016/j.jaci.2020.01.017
Marcus S. Shaker, MD, MSc a, ⁎ 
, Dana V. Wallace, MD b, David B.K. Golden, MD c, John Oppenheimer, MD d, Jonathan A. Bernstein, MD e, Ronna L. Campbell, MD, PhD f, Chitra Dinakar, MD g, Anne Ellis, MD h, Matthew Greenhawt, MD, MBA, MSc i, David A. Khan, MD j, David M. Lang, MD k, Eddy S. Lang, MD l, Jay A. Lieberman, MD m, Jay Portnoy, MD n, Matthew A. Rank, MD o, David R. Stukus, MD p, Julie Wang, MD q,
, Dana V. Wallace, MD b, David B.K. Golden, MD c, John Oppenheimer, MD d, Jonathan A. Bernstein, MD e, Ronna L. Campbell, MD, PhD f, Chitra Dinakar, MD g, Anne Ellis, MD h, Matthew Greenhawt, MD, MBA, MSc i, David A. Khan, MD j, David M. Lang, MD k, Eddy S. Lang, MD l, Jay A. Lieberman, MD m, Jay Portnoy, MD n, Matthew A. Rank, MD o, David R. Stukus, MD p, Julie Wang, MD q, Collaborators
Natalie Riblet, MD, MPH r, Aiyana M.P. Bobrownicki, MPH, MBA r, Teresa Bontrager, RN, BSN, MSNed, CPEN s, Jarrod Dusin, MS, RD, LD s, Jennifer Foley, RT(R)(N), CNMT s, Becky Frederick, PharmD s, Eyitemi Fregene, MD, MPH r, Sage Hellerstedt, MPH r, Ferdaus Hassan, PhD s, Kori Hess, PharmD s, Caroline Horner, MD t, Kelly Huntington, RN, BSN, CPN s, Poojita Kasireddy, MPH r, David Keeler, RN, BSN, CPN s, Bertha Kim, MPH r, Phil Lieberman, MD m, Erin Lindhorst, MS, RD, LD s, Fiona McEnany, MPH r, Jennifer Milbank, MPH r, Helen Murphy, BHS RRT AE-C s, Oriana Pando, MPH r, Ami K. Patel, MPH r, Nicole Ratliff, BS RT(R) s, Robert Rhodes, MHA, RRT-NPS s, Kim Robertson, MBA, MT-BC s, Hope Scott, RN, CPEN s, Audrey Snell, MS, RD, CSP, LD s, Rhonda Sullivan, MS, RD, LD s, Varahi Trivedi, MPH r, Azadeh Wickham, MS, FNP-BC s a Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
b Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
c Division of Allergy-Clinical Immunology, Johns Hopkins University, Baltimore, Md
d Department of Internal Medicine, Pulmonary and Allergy, University of Medicine and Dentistry of New Jersey–Rutgers New Jersey Medical School and Pulmonary and Allergy Associates, Morristown, NJ
e Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
f Department of Emergency Medicine, Mayo Clinic, Rochester, Minn
g Allergy, Asthma, and Immunodeficiency, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, Calif
h Division of Allergy and Immunology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
i Section of Allergy and Immunology, Children’s Hospital Colorado, University of Colorado School of Medicine, Denver, Colo
j Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
k Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
l Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
m Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
n Pediatric Allergy and Immunology, Children’s Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
o Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
p Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
q Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
r The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
s Office of Evidence-Based Practice, Children’s Mercy Hospital, Kansas City, Mo
t Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St. Louis, Mo
∗Corresponding author: Marcus S. Shaker, MD, MSc, FAAAAI, FACAAI, FAAP, Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001.Section of Allergy and Clinical ImmunologyDartmouth-Hitchcock Medical CenterOne Medical Center DriveNH03756-0001Lebanon
Chief Editors
Marcus S. Shaker, Dana V. WallaceWorkgroup Contributors
Marcus S. Shaker, Dana V. Wallace, Jonathan A. Bernstein, Ronna L. Campbell, Chitra Dinakar, Anne Ellis, David B.K. Golden, Matthew Greenhawt, Jay A. Lieberman, Matthew A. Rank, David R. Stukus, Julie WangJoint Task Force on Practice Parameters Reviewers
Marcus S. Shaker, Dana V. Wallace, David B.K. Golden, Jonathan A. Bernstein, Chitra Dinakar, Anne Ellis, Matthew Greenhawt, Caroline Horner, David A. Khan, Jay A. Lieberman, John Oppenheimer, Matthew A. Rank, Marcus S. Shaker, David R. Stukus, Julie WangAbstract |
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.
El texto completo de este artículo está disponible en PDF.Key words : 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
Abbreviations used : AAAAI, ACAAI, ADR, C3a (4a, 5a), DHR, ED, EMS, FAAN, FIA, GRADE, H1 (2, 3, 4), HSR, HVA, I2, IQR, JTFPP, LL, LT, NIAID, NNT, NPV, OR, PAF, PEER, PRISMA, RCM, RIT, RR
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| Disclosure of potential conflict of interest: The JTFPP members and work group members’ conflict of interest disclosure forms can be found at www.allergyparameters.org. Jonathan Bernstein has received financial support from Sanofi, Regeneron, AstraZeneca, Merck, Optinose, Takeda, CSL Behring, Biocryst, Pharming, the National Institutes of Health, Taylor Francis, INEOS; is Editor in Chief of the Journal of Asthma, INEOS Medical Immunosurveillance Director, Vice Chair and Lectureship Chair of the American Academy of Allergy, Asthma & Immunology (AAAAI) Foundation, Chairman of Allergists for Israel, American College of Asthma, Allergy, and Immunology (ACAAI) Asthma Chair, Scientific Chair, and Young Investigator Award Chair; and serves of the Board of Directors and Scientific Committee of Interasma. Ronna Campbell has served as a peer reviewer for EB Medicine and an author for UpToDate. Chitra Dinakar has received financial support from Propeller Health, ACAAI (stipend for Editorial Board of AllergyWatch), the American Association of Allergists of Indian Origin; serves on the Board of Directors of the AAAAI and on the Medical Advisory Board of Food Equity Initiative; is Assistant Editor of AllergyWatch. Anne Ellis has received financial support from ALK-Abello, AstraZeneca, Green Cross, Merck, Novartis, Nuvo, Pediapharm, Pfizer, Kaleo, Novartis, Sanofi, Regeneron; serves on the Board of Directors of the Canadian Allergy Society of Allergy and Clinical Immunology. David Golden has received financial support from Aquestive, Sandoz, ALK-Abello, Sandoz, Genentech, Stallergenes-Greer, and UpToDate. Matthew Greenhawt has received financial support from Aquestive, Merck, Allergenis, Allergy Therapeutics, Sanofi Genzyme, Genentech, Aravax, Prota, Before Brands, the Institute for Clinical and Economic Review, ACAAI, DBV, Intrommune; is supported by the Agency of Healthcare Research and Quality; has served on the advisory board of International Food Protein-Induced Enterocolitis Syndrome Association, the Asthma and Allergy Foundation of America, and the National Peanut Board; and is Associate Editor of the Annals of Allergy, Asthma, and Immunology. Caroline Horner has served as committee chair for the AAAAI Asthma Diagnosis and Treatment Interest Section, Interest Section Coordinating Committee, and In-Training Exam Coordinating Committee. David Khan has received financial support from UpToDate and Aimmune; serves on the Board of Directors of the AAAAI, ACAAI Chair of Literature Review, Co-Chair of Conjoint Board Review, Texas Allergy, Asthma, and Immunology Society Chair of Meetings Committee; and is Associate Editor of the Journal of Allergy and Clinical Immunology In Practice. Eddy Lang received an honorarium from the Joint Task Force on Practice Parameters for Grading of Recommendations, Assessment, Development and Evaluation methods support. Jay Lieberman has received financial support from the ACAAI, Aquestive, Aimmune, DBV, Biotest Pharma, and Regeneron; is Associate Editor of the Annals of Allergy, Asthma, and Immunology, Vice Chair for the ACAAI Food Allergy Committee, and Medical Director for Food Allergy Alliance of the MidSouth. John Oppenheimer has received financial support from DBV, Teva Pharmaceutical Industries, GlaxoSmithKline adjudication/data safety monitoring board, AstraZeneca, Novartis, and Sanofi; is Associate Editor of the Annals of Allergy, Asthma, and Immunology and AllergyWatch, an American Board of Internal Medicine Council Member and American Board of Allergy and Immunology Liaison to the American Board of Internal Medicine, UpToDate Reviewer, American College of Clinical Pharmacy Cough Guideline Committee Member, and WebMD Editor. Jay Portnoy has received financial support from Thermo Fisher Scientific, Kaleo, Teva Pharmaceutical Industries, Novartis, Hycor, and Boehringer-Ingelheim. Matthew Rank has received financial support from the ACAAI, National Institutes of Health, and Levin Family Foundation; has served as Chair of the AAAAI Health outcomes, Education, Delivery, and Quality Interest Section; and is Research Director of the Phoenix Children’s Hospital Breathmobile. Marcus Shaker has received financial support from the Eastern Allergy Conference and has a family member who is Chief Executive Officer of Altrix Medical. David Stukus has received financial support from Aimmune, Before Brands, Abbott Nutrition, the American Academy of Pediatrics, ACAAI; has served as Committee Chair for the AAAAI and ACAAI. Dana Wallace has received financial support from Mylan, Kaleo, Optinose, ALK-Abello, Bryan, and Sanofi; is Education Council Chair and Rhinitis/Sinusitis/Ocular Committee Chair for the ACAAI; is Website Content Editor and ESP/WATS Committee Chair for the World Allergy Organization. Julie Wang has received financial support from ALK-Abello, Regeneron, DBV, Aimmune; is an UpToDate author; serves on the Executive Committee of the American Academy of Pediatrics Section on Allergy and Immunology; and serves as Vice Chair of the AAAAI Anaphylaxis, Dermatitis, Drug Allergy Interest Section. David Lang declares that he has no relevant conflicts of interest. |
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| Reprints: Joint Task Force on Practice Parameters Liaison: Peris Flagg (American Academy of Allergy, Asthma, and Immunology, 555 E. Wells Street, Suite 1100, Milwaukee, WI 53202. E-mail: pflagg@aaaai.org); JTFPP.allergy@gmail.com. |
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| Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are also available at www.allergyparameters.org/, www.aaaai.org/, and www.ACAAI.org. |
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| The Joint Task Force on Practice Parameters (JTFPP) is committed to ensuring that the practice parameters are based on the best scientific evidence at the time of publication, and that such evidence is free of commercial bias to the greatest extent possible. The JTFPP recognizes that experts in a field are likely to have interests that could come into conflict with the development of a completely unbiased and objective practice parameter. To take advantage of their expertise, a process has been developed to acknowledge potential conflicts of interest (COI) and attempt to prevent them from influencing the final document in a negative way. To preserve the greatest transparency regarding potential COI, all members of the JTFPP and the practice parameters work groups will complete a standard potential COI disclosure form prior to the development of each document, which will be available for external review by the sponsoring organization and any other interested individual. In addition, before confirming the selection of the work group chairperson and members, the JTFPP will discuss and resolve all relevant potential COI associated with this selection. Finally, all members of parameter work groups will be provided a written statement regarding the importance of ensuring that the parameter development process is free of commercial bias. During the review process there are additional measures to avoid bias. At the workgroup level, all the sections are reviewed by all work group members to ensure that content is appropriate and without apparent bias. If a section is deemed to have apparent bias, it will be appropriately revised without the section author’s involvement, in an attempt to remove potential bias. In addition, the entire document is then reviewed by the JTFPP, and any apparent bias is acknowledged and removed at that level. For each and every recommendation, a vote is required by the work group and JTFPP, and any member with any perceived COI is recused from that vote (and so explained in the document). Any dissenting votes that cannot be resolved are described and explained in the document. In a final stage of review, the practice parameter is sent to invited expert reviewers for review, selected by the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology (ACAAI). The document is also posted on the AAAAI and ACAAI websites for general membership and the public-at-large to review and offer comment. All reviewers must provide statements of potential COI. Although the JTFPP has the final responsibility for the content of the documents submitted for publication, each reviewer’s comments will be discussed and reviewers will receive written responses to comments when appropriate. |
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| Disclaimer: The AAAAI and the ACAAI have jointly accepted responsibility for establishing “Anaphylaxis—a 2019 practice parameter update, systematic review and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis.” This is a complete and comprehensive document and is current at the time of publication. The medical environment is rapidly changing and not all recommendations will be appropriate or applicable to all patients and may change over time. Because this document incorporated the efforts of many participants, no single individual, including members serving on JTFPP, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the executive offices of the AAAAI and the ACAAI. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. |
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| Contributors: The Joint Task Force has made a concerted effort to acknowledge all contributors to this parameter. If any contributors have been excluded inadvertently, the Task Force will ensure that appropriate recognition of such contributions is made subsequently. |
© 2020
American Academy of Allergy, Asthma & Immunology. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
Vol 145 - N° 4
P. 1082-1123 - avril 2020 Regresar al número
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