Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1082-1123 |
| Number of pages | 42 |
| Journal | Journal of Allergy and Clinical Immunology |
| Volume | 145 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2020 |
Keywords
- Anaphylaxis
- GRADE
- allergen immunotherapy
- antihistamines
- biphasic
- chemotherapy
- epinephrine
- evidence to recommendations
- glucocorticoids
- guideline
- infliximab
- mAb
- practice parameter
- pretreatment
- radiocontrast media
- risk factors
- severity
- systematic meta-analysis
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
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In: Journal of Allergy and Clinical Immunology, Vol. 145, No. 4, 04.2020, p. 1082-1123.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis
AU - Collaborators
AU - Chief Editors
AU - Workgroup Contributors
AU - Joint Task Force on Practice Parameters Reviewers
AU - Shaker, Marcus S.
AU - Wallace, Dana V.
AU - Golden, David B.K.
AU - Oppenheimer, John
AU - Bernstein, Jonathan A.
AU - Campbell, Ronna L.
AU - Dinakar, Chitra
AU - Ellis, Anne
AU - Greenhawt, Matthew
AU - Khan, David A.
AU - Lang, David M.
AU - Lang, Eddy S.
AU - Lieberman, Jay A.
AU - Portnoy, Jay
AU - Rank, Matthew A.
AU - Stukus, David R.
AU - Wang, Julie
AU - Riblet, Natalie
AU - Bobrownicki, Aiyana M.P.
AU - Bontrager, Teresa
AU - Dusin, Jarrod
AU - Foley, Jennifer
AU - Frederick, Becky
AU - Fregene, Eyitemi
AU - Hellerstedt, Sage
AU - Hassan, Ferdaus
AU - Hess, Kori
AU - Horner, Caroline
AU - Huntington, Kelly
AU - Kasireddy, Poojita
AU - Keeler, David
AU - Kim, Bertha
AU - Lieberman, Phil
AU - Lindhorst, Erin
AU - McEnany, Fiona
AU - Milbank, Jennifer
AU - Murphy, Helen
AU - Pando, Oriana
AU - Patel, Ami K.
AU - Ratliff, Nicole
AU - Rhodes, Robert
AU - Robertson, Kim
AU - Scott, Hope
AU - Snell, Audrey
AU - Sullivan, Rhonda
AU - Trivedi, Varahi
AU - Wickham, Azadeh
N1 - Funding Information: 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. Funding Information: 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. Publisher Copyright: © 2020 American Academy of Allergy, Asthma & Immunology
PY - 2020/4
Y1 - 2020/4
N2 - 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.
AB - 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.
KW - Anaphylaxis
KW - GRADE
KW - allergen immunotherapy
KW - antihistamines
KW - biphasic
KW - chemotherapy
KW - epinephrine
KW - evidence to recommendations
KW - glucocorticoids
KW - guideline
KW - infliximab
KW - mAb
KW - practice parameter
KW - pretreatment
KW - radiocontrast media
KW - risk factors
KW - severity
KW - systematic meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85082423214&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85082423214&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2020.01.017
DO - 10.1016/j.jaci.2020.01.017
M3 - Article
C2 - 32001253
AN - SCOPUS:85082423214
SN - 0091-6749
VL - 145
SP - 1082
EP - 1123
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 4
ER -