Anaphylaxis is a potentially life-threatening medical emergency and a challenge for emergency healthcare providers. There appears to be a lack of consistency in the international definition and management of anaphylaxis. The objective of this study was to review current international guidelines in diagnostic and management of anaphylaxis in the pre-hospital setting.
A literature search was conducted of the medical related electronic databases, Ovid MEDLINE, Cinahl, Cochrane CENTRAL and EMBASE from 1980 to the end of May 2013. A previously published pre-hospital search filter was used in each of the databases including additional keywords, ‘anaphylaxis’, ‘diagnosis’, ‘hypersensitivity’, ‘allergy’, ‘allergic reaction’, ‘adrenaline’, ‘epinephrine’ and ‘antihistamine’. Articles were included if their primary aim was to report of the evidence used to create international guidelines of anaphylaxis diagnosis and management. The references of retrieved articles were also reviewed. Articles were excluded if they were not written in English.
There were 128 articles located by the search with 18 meeting the inclusion criteria. Of these, three were literature reviews and six reported on the introduction of anaphylaxis guidelines, including medical treatment in different countries. Three retrospective studies evaluated the efficiency of current diagnostic and management in hospital setting. Two questionnaire surveys were conducted internationally. There were two articles proposing diagnostic criteria and a rating method for anaphylaxis. Two were relevant to pre-hospital studies.
The inconsistency of definition and diagnosis criteria increases the risk of under-diagnosis and under-treatment of patients with anaphylaxis. Emergency healthcare providers need a more explicit set of diagnosis criteria and guidelines for treatment to rapidly relieve patients’ anaphylactic reaction and potentially life-threatening situation.
Jacobsen RC, Gratton MC. A case of unrecognized prehospital anaphylactic shock. Prehosp Emerg Care 2011;15:61–6.
Sanders MJ. Mosby’s Paramedic Textbook. 3rd edn, Elsevier Mosby, 2006.
Simons FER, Ardusso LRF, Bilò MB, et al. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol 2011;127:587–93.
Working Group of the Resuscitation Council (UK). Emergency treatment of anaphylactic reactions - Guidelines for healthcare providers. Resuscitation Council (UK); 2013, p. 49.
Lieberman P, Camargo CA, Jr., Bohlke K, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol 2006;97(5):596–602.
Poulos LM, Waters AM, Correll PK, Loblay RH, Marks GB. Trends in hospitalizations for anaphylaxis, angioedema, and urticaria in Australia, 1993-1994 to 2004-2005. J Allergy Clin Immunol 2007;120(4):878–84.
Brown AFT, McKinnon D, Chu K. Emergency department anaphylaxis: A review of 142 patients in a single year. J Allergy Clin Immunol 2001;108(5):861–6.
Braganza SC, Acworth JP, Mckinnon DRL, Peake JE, Brown AFT. Paediatric emergency department anaphylaxis: different patterns from adults. Arch Dis Child 2006;91(2):159–63.
Australian Resuscitation Council. Anaphylaxis – First Aid Management. The Australian Resuscitation Council Guidelines. Melbourne, Victoria: Australian Resuscitation Council; 2012, p. 9–10.
Alrasbi M, Sheikh A. Comparison of international guidelines for the emergency medical management of anaphylaxis. Allergy 2007;62:838–41.
Capps J, Sharma V, Arkwright P. Prevalence, outcome and pre-hospital management of anaphylaxis by first aiders and paramedical ambulance staff in Manchester, UK. Resuscitation 2010;81:653–7.
Grabenhenrich L, Hompes S, Gough H, et al. Implementation of anaphylaxis management guidelines: a register-based study. PLoS One 2012;7:e35778.
Beyer K, Eckermann O, Hompes S, Grabenhenrich L, Worm M. Anaphylaxis in an emergency setting - elicitors, therapy and incidence of severe allergic reactions. Allergy 2012;67:1451–6.
Choo K, Simons F, Sheikh A. Glucocorticoids for the treatment of anaphylaxis. The Cochrane Library, 2010.
Sheikh A, Broek Vt. H1 antihistamines for the treatment of anaphylaxis with and without shock. The Cochrane Library, 2007.
Sheikh A, Shehata Y. Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock. The Cochrane Library, 2008.
Simons F, Estelle R. World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings. Ann Allergy Asthma Immunol 2010;104:405–12.
Campbell RL, Hagan JB, Manivannan V, et al. Evaluation of national institute of allergy and infectious diseases/food allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients. J Allergy Clinical Immunol 2012;129:748–52.
Australian Resuscitation Council. Guideline 11.10 Resuscitation in Special Circumstance. The Australian Resuscitation Council Guidelines. Melbourne, Victoria: Australian Resuscitation Council; 2011, p. 1–14.
Ambulance Victoria. Ambulance Victoria Clinical practice guidelines for ambulance and MICA paramedics. Victoria: Ambulance Victoria; 2014.
Australian Society of Clinical Immunology and Allergy. ASCIA Action Plan for Allergic Reactions, 2013. Available at: www.allergy.org.au/ [Accessed 17 June 2013].
Harduar-Morano L, Simon MR, Watkins S, Blackmore C. Algorithm for the diagnosis of anaphylaxis and its validation using population-based data on emergency department visits for anaphylaxis in Florida. J Allergy Clin Immunol 2010;126:98–104.
Brown SGa. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol 2004;114:371–6.
Brown SGA, Mullins RJ, Gold MS. Anaphylaxis: Diagnosis and management. Med J Aust 2006;185:283–9.
Kirkbright SJ. Anaphylaxis: recognition and management. Aust Fam Physician 2012;41:366–70.