Effective treatment of anaphylaxis: A Synthesis of Findings from 16 Studies

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Original Abstract of the Article

Major Findings

Anaphylaxis is a serious allergic reaction that can be life-threatening. 4 , 5 , 10 Studies show that adrenaline is recommended for the treatment of anaphylaxis and its effectiveness is established. 12 , 5 , 6 Intramuscular injection is considered the optimal administration method for adrenaline. 12 Delay or failure to administer adrenaline may increase the risk of death. 12 In children, studies suggest that intramuscular injection is better than subcutaneous injection for adrenaline absorption. 1 In addition to adrenaline, antihistamines and corticosteroids may be used in anaphylaxis treatment. However, there is still not enough research on the effectiveness of these drugs. 4 , , 9 , 11 , 8 Corticosteroids can be used to prevent anaphylaxis. 11 Also, allergen-specific immunotherapy can be effective in preventing anaphylaxis. 12 Patients should be educated about the risk of anaphylaxis recurrence, trigger avoidance, self-injectable epinephrine education, referral to an allergist, and thresholds for further care to prevent anaphylaxis recurrence. 15 Use of adrenaline self-injectors such as EpiPen is crucial for the treatment of anaphylaxis. 10 The design of EpiPen is essential for proper use in an emergency, and studies have shown that easier-to-use EpiPens are more likely to be used correctly. 14

treatment summary

Adrenaline is recommended as the first-line treatment for anaphylaxis. 12 , 5 , 6 Intramuscular injection is considered the optimal administration method. 12 For children, studies suggest that intramuscular injection is better than subcutaneous injection for adrenaline absorption. 1 Antihistamines and corticosteroids may be used as adjunctive therapies in anaphylaxis treatment, but their effectiveness has not been fully studied. 4 , , 9 , 11 , 8 Corticosteroids can be used to prevent anaphylaxis. 11 Allergen-specific immunotherapy may be effective in preventing anaphylaxis. 12 Patients should be educated about the risk of anaphylaxis recurrence, trigger avoidance, self-injectable epinephrine education, referral to an allergist, and thresholds for further care to prevent anaphylaxis recurrence. 15

Benefits and Risks

Benefit Summary

Adrenaline is recommended as the first-line treatment for anaphylaxis and its effectiveness is established. 12 , 5 , 6 Intramuscular adrenaline injection is expected to improve anaphylaxis symptoms and reduce the risk of death. 12 Allergen-specific immunotherapy can be effective in preventing anaphylaxis. 12

Risk Summary

Adrenaline administration may cause side effects such as increased heart rate, increased blood pressure, anxiety, tremor, nausea, and vomiting. 1 Delay or failure to administer adrenaline may increase the risk of death. 12 The effectiveness of antihistamines and corticosteroids used in the treatment of anaphylaxis has not been fully studied. 4 , , 9 , 11 , 8 While corticosteroids are used to prevent anaphylaxis, their effectiveness has not been fully studied. 11

Comparison Between Studies

Commonalities of Studies

Many studies have shown that adrenaline is recommended as the first-line treatment for anaphylaxis. 12 , 5 , 6 Studies also suggest that allergen-specific immunotherapy may be effective in preventing anaphylaxis. 12

Differences in Studies

Some studies highlight differences in the administration method for adrenaline. 12 , 1 For example, in children, intramuscular injection has been shown to be better than subcutaneous injection for adrenaline absorption. 1 Also, the effectiveness of antihistamines and corticosteroids used in the treatment of anaphylaxis has not been fully studied. 4 , , 9 , 11 , 8

Consistency and Contradictions in Results

Many studies agree that adrenaline is recommended for the treatment of anaphylaxis. 12 , 5 , 6 However, there is not enough research yet on the administration method of adrenaline, the effectiveness of antihistamines and corticosteroids, and contradictions can be seen in the results. 1 , 4 , , 9 , 11 , 8

Cautions for Real-Life Application

Anaphylaxis is a serious allergic reaction that can be life-threatening. 4 , 5 , 10 It's important to seek medical attention immediately if you suspect anaphylaxis. 12 While allergen-specific immunotherapy may be effective in preventing anaphylaxis, it should be done under the guidance of a specialist. 12 If you carry a self-injectable epinephrine, it is important to practice using it beforehand so you can use it correctly in case of anaphylaxis. 10 If you experience symptoms of anaphylaxis, administer epinephrine promptly and seek medical attention. 12

Limitations of Current Research

There is still not enough research on the treatment and prevention of anaphylaxis. 4 , , 9 , 11 , 8 In particular, there is not enough research on the effectiveness of antihistamines and corticosteroids. 4 , , 9 , 11 , 8 Further research is also needed on the administration method and appropriate dosage of adrenaline. 1 , 12

Future Research Directions

Research on the treatment and prevention of anaphylaxis should continue. 4 , , 9 , 11 , 8 In particular, research on the effectiveness of antihistamines and corticosteroids, the administration method and appropriate dosage of adrenaline, and the prevention of anaphylaxis is needed. 4 , , 9 , 11 , 8 , 1 , 12

Conclusion

Anaphylaxis is a serious allergic reaction that can be life-threatening. 4 , 5 , 10 It's important to seek medical attention immediately if you suspect anaphylaxis. 12 Adrenaline is recommended as the first-line treatment for anaphylaxis, and its effectiveness is established. 12 , 5 , 6 Intramuscular injection is considered the optimal administration method for adrenaline. 12 Allergen-specific immunotherapy may be effective in preventing anaphylaxis. 12 Patients should be educated about the risk of anaphylaxis recurrence, trigger avoidance, self-injectable epinephrine education, referral to an allergist, and thresholds for further care to prevent anaphylaxis recurrence. 15 Research on the treatment of anaphylaxis should continue, especially focusing on the effectiveness of antihistamines and corticosteroids, the administration method and appropriate dosage of adrenaline, and the prevention of anaphylaxis. 4 , , 9 , 11 , 8 , 1 , 12

List of Treatments

Adrenaline, antihistamines, corticosteroids, allergen-specific immunotherapy, EpiPen

Literature analysis of 16 papers
Positive Content
9
Neutral Content
1
Negative Content
6
Article Type
3
1
13
11
16
1.

Epinephrine absorption in children with a history of anaphylaxis.

Author: SimonsF E, RobertsJ R, GuX, SimonsK J

Epinephrine absorption faster IM
Delayed subcutaneous absorption

Subcutaneous epinephrine absorption in children is slower than intramuscular injection, potentially delaying treatment for systemic anaphylaxis. Intramuscular injection is recommended due to faster absorption and no observed serious adverse effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

2.

Analysis of the burden of treatment in patients receiving an EpiPen for yellow jacket anaphylaxis.

Author: Oude ElberinkJoanne N G, van der HeideS, GuyattGordon H, DuboisAnthony E J

Allergy treatment

The study discussed the effectiveness of venom immunotherapy (VIT) for the prevention of anaphylactic reactions in patients with Hymenoptera allergy, noting the potential for both VIT and EpiPen use to have negative aspects.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Validation StudyResearch to assess the validity and reliability of new measurement methods or diagnostic tests.

Language : English

3.

H1-antihistamines for the treatment of anaphylaxis with and without shock.

Author: SheikhA, ten BroekV m, BrownS G A, SimonsF E R

Anaphylaxis treatment
No evidence

No studies were found that satisfied the inclusion criteria.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

4.

H1-antihistamines for the treatment of anaphylaxis: Cochrane systematic review.

Author: SheikhA, Ten BroekV, BrownS G A, SimonsF E R

There is no evidence to support or refute the benefits or harms of H(1)-antihistamines in the treatment of anaphylaxis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

5.

Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.

Author: SheikhAziz, ShehataYasser A, BrownSimon Ga, SimonsF Estelle R

Anaphylaxis treatment

There is no evidence to recommend the use of adrenaline for the treatment of anaphylaxis. However, due to the critical importance of prompt treatment for survival, adrenaline administration by intramuscular injection is recommended as first-line treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

6.

Adrenaline for the treatment of anaphylaxis: cochrane systematic review.

Author: SheikhA, ShehataY A, BrownS G A, SimonsF E R

There is insufficient evidence to make new recommendations on the use of adrenaline for the treatment of anaphylaxis. Despite the lack of appropriate trials, adrenaline administration by intramuscular injection should still be considered first-line treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

7.

Glucocorticoids for the treatment of anaphylaxis.

Author: ChooKaren Jui Lin, SimonsF Estelle R, SheikhAziz

There was no evidence to recommend glucocorticoids for the treatment of anaphylaxis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review.

Author: ChooK J L, SimonsE, SheikhAziz

Lack of evidence

There is no evidence from high-quality studies for the use of steroids in the emergency management of anaphylaxis. Therefore, we can neither support nor refute the use of these drugs for this purpose.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

9.

Glucocorticoids for the treatment of anaphylaxis.

Author: ChooKaren Jui Lin, SimonsF Estelle R, SheikhAziz

Anaphylaxis treatment
No evidence

This review of available literature found no randomized controlled trials comparing glucocorticoids with any control for the treatment of anaphylaxis. Therefore, no recommendations can be made regarding the use of glucocorticoids in the treatment of anaphylaxis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community.

Author: SheikhAziz, SimonsF Estelle R, BarbourVictoria, WorthAllison

Treatment of anaphylaxis

Anaphylaxis is a severe allergic reaction that can be fatal. Adrenaline (epinephrine) auto-injectors are recommended as the first treatment for anaphylaxis, but they are not always available and have limitations in their use.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Glucocorticosteroids for the treatment and prevention of anaphylaxis.

Author: SheikhAziz

Delayed epinephrine
Ineffective

Glucocorticosteroids are of questionable benefit in the emergency management of anaphylaxis and routine premedication is unlikely to confer clinical benefit in patients receiving iodinated contrast media, snake anti-venom therapy, or allergen immunotherapy.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

12.

Management of anaphylaxis: a systematic review.

Author: DhamiS, PanesarS S, RobertsG, MuraroA, WormM, BilòM B, CardonaV, DuboisA E J, DunnGalvinA, EigenmannP, Fernandez-RivasM, HalkenS, LackG, NiggemannB, RueffF, SantosA F, Vlieg-BoerstraB, ZolkipliZ Q, SheikhA,

Adrenaline administration
Anaphylaxis
Death risk

This review examines the effectiveness of interventions for managing anaphylaxis. While there is limited evidence for the effectiveness of adrenaline, H1-antihistamines, systemic glucocorticosteroids, or methylxanthines, the study suggests that intramuscular adrenaline into the middle of the vastus lateralis muscle is the optimal treatment route. Delaying or failing to administer adrenaline may increase the risk of death. Long-term management interventions, such as anaphylaxis management plans and allergen-specific immunotherapy, may be beneficial, but require further research.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

13.

H2-antihistamines for the treatment of anaphylaxis with and without shock: a systematic review.

Author: NurmatovUlugbek B, RhatiganEdmund, SimonsF Estelle R, SheikhAziz

This systematic review found no eligible studies to assess the benefits and harms of H2-antihistamines in the treatment of anaphylaxis. Well-designed randomized controlled trials are urgently needed.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

14.

Usability and preference of epinephrine auto-injectors: Auvi-Q and EpiPen Jr.

Author: KesslerCatherine, EdwardsEvan, DissingerEmily, SyeSamantha, VisichTimothy, GrantEdward

Improved usability

Auvi-Q, an epinephrine auto-injector (EAI), was found to be more usable and preferred by untrained adults compared to EpiPen Jr in a simulated life-threatening allergic emergency. The study found that significantly more participants correctly completed all injection tasks per device instructions with Auvi-Q (85.4%) compared to EpiPen Jr (19.8%). Auvi-Q also had fewer digital/hand injection errors, highlighting the importance of device design for successful epinephrine administration.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

15.

Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis.

Author: ShakerMarcus S, WallaceDana V, GoldenDavid B K, OppenheimerJohn, BernsteinJonathan A, CampbellRonna L, DinakarChitra, EllisAnne, GreenhawtMatthew, KhanDavid A, LangDavid M, LangEddy S, LiebermanJay A, PortnoyJay, RankMatthew A, StukusDavid R, WangJulie, , RibletNatalie, BobrownickiAiyana M P, BontragerTeresa, DusinJarrod, FoleyJennifer, FrederickBecky, FregeneEyitemi, HellerstedtSage, HassanFerdaus, HessKori, HornerCaroline, HuntingtonKelly, KasireddyPoojita, KeelerDavid, KimBertha, LiebermanPhil, LindhorstErin, McEnanyFiona, MilbankJennifer, MurphyHelen, PandoOriana, PatelAmi K, RatliffNicole, RhodesRobert, RobertsonKim, ScottHope, SnellAudrey, SullivanRhonda, TrivediVarahi, WickhamAzadeh

Anaphylaxis treatment

Anaphylaxis is a serious, potentially life-threatening allergic reaction. People who have severe anaphylaxis or need multiple doses of epinephrine are at risk for a second reaction. While antihistamines and corticosteroids may be used in certain situations, they don't reliably prevent a second reaction. Epinephrine is the primary treatment for anaphylaxis. After treatment, people should be closely monitored until their symptoms are fully gone. All those who experience anaphylaxis should learn about the condition, how to avoid triggers, how to use an epinephrine auto-injector, and when to seek further medical care.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

16.

Use of omalizumab for management of idiopathic anaphylaxis: A systematic review and retrospective case series.

Author: KaminskyLauren W, AukstuolisKestutis, PetroniDaniel H, Al-ShaikhlyTaha

Anaphylaxis treatment

Omalizumab, an anti-IgE antibody, showed potential benefit for patients with idiopathic anaphylaxis (IA) who failed to respond to conventional therapies. In a retrospective review of 35 IA patients without evidence of mast cell clonality, omalizumab led to complete response in 63% and partial response in 28.5%.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

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