Allergic Reaction


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


COCHRANE SYSTEMATIC REVIEW: H1-antihistamines for the treatment of anaphylaxis with and without shock
Implications for practice: Unknown effectiveness – there is no evidence from trials to support practice
Review Overview: Anaphylaxis is a rare, but potentially life-threatening emergency caused by an acute systemic allergic reaction. H1-antihistamines are commonly used for the emergency treatment of anaphylaxis, although there is no evidence from randomized controlled trials to support this use.
LINK to Cochrane Library: Issue 1 2007 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006160/frame.html