COCHRANE SYSTEMATIC REVIEW: Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community
Implications for practice: Adrenaline is still the first line treatment for anaphylaxis regardless of how it is most quickly accesses in the emergency.
Review Overview: Based on this review, we cannot make any new recommendations on the effectiveness of adrenaline auto-injectors for the treatment of anaphylaxis. Although randomized, double-blind, placebo-controlled clinical trials of high methodological quality are necessary to define the true extent of benefits from the administration of adrenaline in anaphylaxis via an auto-injector, such trials are unlikely to be performed in individuals experiencing anaphylaxis because of ethical concerns associated with randomization to placebo. There is, however, a need to consider trials in which, for example, auto-injectors of different doses of adrenaline and differing devices are compared in order to provide greater clarity on the dose and device of choice. Such trials would be practically challenging to conduct. In the absence of appropriate trials, we recommend that adrenaline administration by auto-injector should still be regarded as the most effective first-line treatment for the management of anaphylaxis in the community. In countries where auto-injectors are not commonly used, it may be possible to conduct trials to compare administration of adrenaline via auto-injector with adrenaline administered by syringe and ampoule, or comparing the effectiveness of two different types of auto-injectors.
LINK to Cochrane Library: Issue 8, 2012
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008935.pub2/abstract;jsessionid=3621174E1297629956977F03C25A7B0B.d01t03
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