Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium.
Icahn School of Medicine at Mount Sinai1, Mayo Clinic2, Johns Hopkins University3, Centers for Disease Control and Prevention4, Fremantle Hospital5, Harvard University6, Case Western Reserve University7, Stanford University8, University of Texas at Dallas9, American Academy of Pediatrics10, American Society of Anesthesiologists11, The American College of Financial Services12, National Institutes of Health13, University of Padua14, American College of Emergency Physicians15
01 Feb 2006-The Journal of Allergy and Clinical Immunology (Mosby Inc.)-Vol. 117, Iss: 2, pp 391-397
TL;DR: There is no universal agreement on the definition of anaphylaxis or the criteria for diagnosis, so representatives from 16 different organizations or government bodies, including representatives from North America, Europe, and Australia, to continue working toward a universally accepted definition.
Abstract: There is no universal agreement on the definition of anaphylaxis or the criteria for diagnosis. In July 2005, the National Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network convened a second meeting on anaphylaxis, which included representatives from 16 different organizations or government bodies, including representatives from North America, Europe, and Australia, to continue working toward a universally accepted definition of anaphylaxis, establish clinical criteria that would accurately identify cases of anaphylaxis with high precision, further review the evidence on the most appropriate management of anaphylaxis, and outline the research needs in this area.
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TL;DR: Lymphedema is a common complication after treatment for breast cancer and factors associated with increased risk of lymphedEMA include extent of axillary surgery, axillary radiation, infection, and patient obesity.
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Heart of England NHS Foundation Trust1, University of Warwick2, University of Helsinki3, Oslo University Hospital4, University of Antwerp5, Ghent University6, Innsbruck Medical University7, Mario Negri Institute for Pharmacological Research8, Southmead Hospital9, The Catholic University of America10, Imperial College Healthcare11, Royal United Hospital12, Imperial College London13, University of Bern14
TL;DR: This chapter contains guidance on the techniques used during the initial resuscitation of an adult cardiac arrest victim and the use of an automated external defibrillator (AED).
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University of Padua1, Humboldt University of Berlin2, Technische Universität München3, Hospital Clínico San Carlos4, Odense University5, University of Cambridge6, University of Montpellier7, University College Cork8, University of Geneva9, University of London10, Media Research Center11, Ludwig Maximilian University of Munich12, University of Amsterdam13, Hannover Medical School14, Swiss Institute of Allergy and Asthma Research15, University of Edinburgh16
TL;DR: These guidelines aim to provide evidence‐based recommendations for the recognition, risk factor assessment, and the management of patients who are at risk of, are experiencing, or have experienced anaphylaxis, and to prevent future episodes by developing personalized risk reduction strategies including, where possible, commencing allergen immunotherapy.
Abstract: Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide evidence-based recommendations for the recognition, risk factor assessment, and the management of patients who are at risk of, are experiencing, or have experienced anaphylaxis. While the primary audience is allergists, these guidelines are also relevant to all other healthcare professionals. The development of these guidelines has been underpinned by two systematic reviews of the literature, both on the epidemiology and on clinical management of anaphylaxis. Anaphylaxis is a potentially life-threatening condition whose clinical diagnosis is based on recognition of a constellation of presenting features. First-line treatment for anaphylaxis is intramuscular adrenaline. Useful second-line interventions may include removing the trigger where possible, calling for help, correct positioning of the patient, high-flow oxygen, intravenous fluids, inhaled short-acting bronchodilators, and nebulized adrenaline. Discharge arrangements should involve an assessment of the risk of further reactions, a management plan with an anaphylaxis emergency action plan, and, where appropriate, prescribing an adrenaline auto-injector. If an adrenaline auto-injector is prescribed, education on when and how to use the device should be provided. Specialist follow-up is essential to investigate possible triggers, to perform a comprehensive risk assessment, and to prevent future episodes by developing personalized risk reduction strategies including, where possible, commencing allergen immunotherapy. Training for the patient and all caregivers is essential. There are still many gaps in the evidence base for anaphylaxis.
827 citations
Cites background from "Second symposium on the definition ..."
...Widely accepted criteria to help clinicians identify likely anaphylaxis (17, 18) (Box 4) emphasize the rapid onset of its multiple symptoms and signs....
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University of Southampton1, North Bristol NHS Trust2, Haukeland University Hospital3, James Cook University Hospital4, University of Mainz5, Queen Mary University of London6, Heart of England NHS Foundation Trust7, The Catholic University of America8, Children's of Alabama9, Imperial College Healthcare10, University of Bristol11
TL;DR: The guidelines for resuscitation in special circumstances section Collaborators1 are published on behalf of the Cardiac arrest in special ircumstances section Collaborator1.
684 citations
Icahn School of Medicine at Mount Sinai1, University of California, San Diego2, University of Colorado Denver3, University of Arkansas for Medical Sciences4, Cleveland Clinic5, Stanford University6, Yale University7, Scripps Research Institute8, University of North Carolina at Chapel Hill9, Johns Hopkins University10, University of Cincinnati11, University of Texas Southwestern Medical Center12, George Washington University13, University of Missouri–Kansas City14, Pennsylvania State University15, University of California, Los Angeles16, University of Washington17, Nova Southeastern University18
TL;DR: This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI), the American College of Allerg, Acetiology & Infectious Diseases (ACAAI); and the Joint Council of Allergic, Aceto-Allergy, Immunology and Immunology(JCAAI) as discussed by the authors.
Abstract: This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update—2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, 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, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.
612 citations
References
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TL;DR: Six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation were identified and the failure to recognize the severity of these reactions and to administer epinephrine promptly increases the risk of a fatal outcome.
Abstract: Background and Methods. Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation. All the cases but one occurred in one of three metropolitan areas over a period of 14 months. Our investigations included a review of emergency medical care reports, medical records, and depositions by witnesses to the events, as well as interviews with parents (and some patients). Results. Of the 13 children and adolescents (age range, 2 to 17 years), 12 had asthma that was well controlled. All had known food allergies, but had unknowingly ingested the foods responsible for the reactions. The reactions were to peanuts (four patients), nuts (six patients), eggs (one patient), and milk (two patients), all of which were contained in foods such as candy, cookies, and pastry. The six patients who died had symptoms within 3 to 30 minute...
1,503 citations
"Second symposium on the definition ..." refers background in this paper
...In a study evaluating patients with fatal or near-fatal food reactions, approximately 20% of patients experienced a biphasic reaction, indicating that biphasic reactions might be more likely in patients who present initially with severe symptoms.(11) The reported time intervals between the initial reaction...
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...Patients who have experienced anaphylaxis from exposures that might be encountered in nonmedical settings should carry self-injectable epinephrine for use if anaphylaxis develops.(5,11) As noted above, there has been no universally accepted definition of anaphylaxis....
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...Unfortunately, no reliable clinical predictors have been identified to enable the identification of patients at increased risk of a biphasic reaction, although some studies have suggested that patients requiring higher doses of epinephrine to control initial symptoms or delayed administration of epinephrine might be associated with increased risk of a biphasic reaction.(11,15,33,34) Generally, the same organ systems are involved in the initial and secondary reaction....
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...d is e a se s, a n d a n a p h y la x is and the onset of the second phase ranged from 1 to 72 hours.(11,27,30-34) Unfortunately, no reliable clinical predictors have been identified to enable the identification of patients at increased risk of a biphasic reaction, although some studies have suggested that patients requiring higher doses of epinephrine to control initial symptoms or delayed administration of epinephrine might be associated with increased risk of a biphasic reaction....
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...The occurrence of biphasic reactions has been established in the literature and appears to occur in 1% to 20% of anaphylactic reactions (as depicted in Table II).(8,11,27,29-34) In a study evaluating patients with fatal or near-fatal food reactions, approximately 20% of patients experienced a biphasic reaction, indicating that biphasic reactions might be more likely in patients who present initially with severe symptoms....
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TL;DR: Fatal anaphylactic reactions to foods are continuing to occur, and better characterization might lead to better prevention, and peanuts and tree nuts accounted for more than 90% of the fatalities.
Abstract: Fatal anaphylactic reactions to foods are continuing to occur, and better characterization might lead to better prevention. The objective of this report is to document the ongoing deaths and characterize these fatalities. We analyzed 32 fatal cases reported to a national registry, which was established by the American Academy of Allergy, Asthma, and Immunology, with the assistance of the Food Allergy and Anaphylaxis Network, and for which adequate data could be collected. Data were collected from multiple sources including a structured questionnaire, which was used to determine the cause of death and associated factors. The 32 individuals could be divided into 2 groups. Group 1 had sufficient data to identify peanut as the responsible food in 14 (67%) and tree nuts in 7 (33%) of cases. In group 2 subjects, 6 (55%) of the fatalities were probably due to peanut, 3 (27%) to tree nuts, and the other 2 cases were probably due to milk and fish (1 [9%] each). The sexes were equally affected; most victims were adolescents or young adults, and all but 1 subject were known to have food allergy before the fatal event. In those subjects for whom data were available, all but 1 was known to have asthma, and most of these individuals did not have epinephrine available at the time of their fatal reaction. Fatalities due to ingestion of allergenic foods in susceptible individuals remain a major health problem. In this series, peanuts and tree nuts accounted for more than 90% of the fatalities. Improved education of the profession, allergic individuals, and the public will be necessary to stop these tragedies.
1,490 citations
"Second symposium on the definition ..." refers background in this paper
...However, limiting prescriptions of self-injectable epinephrine to this criteria in patients with peanut and other nut allergy, for example, would fail to cover up to 80% of patients experiencing a fatal anaphylactic reaction.(35) Patients who are prescribed self-injectable epinephrine should also have an emergency action plan detailing its use and the follow-up management....
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TL;DR: A simple grading system and definition of anaphylaxis has potential value for defining reaction severity in clinical practice and research settings and appears to be the major determinants of reaction severity.
Abstract: Background Existing grading systems for acute systemic hypersensitivity reactions vary considerably, have a number of deficiencies, and lack a consistent definition of anaphylaxis. Objective The aims of this study were to develop a simple grading system and definition of anaphylaxis and to identify predictors of reaction severity. Methods Case records from 1149 systemic hypersensitivity reactions presenting to an emergency department were analyzed retrospectively. Logistic regression analyses of the associations between individual reaction features and hypotension and hypoxia were used to construct a grading system. Epinephrine use, etiology, age, sex, comorbidities, and concurrent medications were then assessed for their association with reaction grade. Results Confusion, collapse, unconsciousness, and incontinence were strongly associated with hypotension and hypoxia and were used to define severe reactions. Diaphoresis, vomiting, presyncope, dyspnea, stridor, wheeze, chest/throat tightness, nausea, vomiting, and abdominal pain had weaker, albeit significant, associations and were used to define moderate reactions. Reactions limited to the skin (urticaria, erythema, and angioedema) were defined as mild. These grades correlated well with epinephrine usage. Older age, insect venom, and iatrogenic causes were independent predictors of severity. Preexisting lung disease was associated with an increased risk of hypoxia. Conclusion This simple grading system has potential value for defining reaction severity in clinical practice and research settings. The moderate and severe grades provide a workable definition of anaphylaxis. Age, reaction precipitant, and preexisting lung disease appear to be the major determinants of reaction severity.
749 citations
"Second symposium on the definition ..." refers background in this paper
...Gastrointestinal symptoms were included as a pertinent target response because they have been associated with severe outcomes in various anaphylactic reactions.(9) Finally, criterion 3 should identify the rare patients who experience an acute hypotensive episode after exposure to a known allergen, as described by Pumphrey and Stanworth....
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Icahn School of Medicine at Mount Sinai1, Food and Drug Administration2, American College of Emergency Physicians3, Stanford University4, Johns Hopkins University5, University of Texas Southwestern Medical Center6, American Academy of Pediatrics7, Harvard University8, University of Pennsylvania9, Medical University of South Carolina10, National Institutes of Health11, University of Virginia12, National Health Service13, University of Manitoba14
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Abstract: Hugh A. Sampson, MD, Anne Munoz-Furlong, BA, S. Allan Bock, MD, Cara Schmitt, MS, Robert Bass, MD, Badrul A. Chowdhury, MD, Wyatt W. Decker, MD, Terence J. Furlong, MS, Stephen J. Galli, MD, David B. Golden, MD, Rebecca S. Gruchalla, MD, Allen D. Harlor, Jr, MD, David L. Hepner, MD, Marilyn Howarth, MD, Allen P. Kaplan, MD, Jerrold H. Levy, MD, Lawrence M. Lewis, MD, Phillip L. Lieberman, MD, Dean D. Metcalfe, MD, Ramon Murphy, MD, Susan M. Pollart, MD, Richard S. Pumphrey, MD, Lanny J. Rosenwasser, MD, F. Estelle Simons, MD, Joseph P. Wood, MD, and Carlos A. Camargo, Jr, MD New York, NY, Fairfax and Charlottesville, Va, Boulder and Denver, Colo, Baltimore, Rockville, and Bethesda, Md, Rochester, Minn, Stanford, Calif, Dallas, Tex, Eugene, Ore, Boston, Mass, Philadelphia, Pa, Charleston, SC, Atlanta, Ga, St Louis, Mo, Cordova, Tenn, Scottsdale, Ariz, Manchester, United Kingdom, and Winnipeg, Manitoba, Canada
641 citations
"Second symposium on the definition ..." refers background in this paper
...In an attempt to resolve these problems, the National Institute of Allergy and Infectious Disease (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) convened a meeting in April 2004 to address these deficiencies.(4) This 2-day symposium brought together experts and representatives from 13 professional, governmental, and lay organizations to address the issue of defining and managing anaphylaxis....
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TL;DR: There are clinically relevant differences among H1-antihistamines in their pharmacology and safety profiles in allergic rhinoconjunctivitis and chronic urticaria.
Abstract: Histamine has an important role as a chemical messenger in physiologic responses, neurotransmission, allergic inflammation, and immunomodulation by way of the H1-receptor. Most H1-antihistamines, which are useful in treating these effects, possess similar efficacy in allergic rhinoconjunctivitis and chronic urticaria. However, there are clinically relevant differences among them in their pharmacology and safety profiles.
570 citations