Diphenhydramine
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Qualitative descriptions of anaphylactoid severity in response to epinephrine.
|
Patient
|
Other
|
Delli Colli L, Al Ali A, Gabrielli S, et al. Managing anaphylaxis: Epinephrine, antihistamines, and corticosteroids: More than 10 years of Cross-Canada Anaphylaxis REgistry data. Ann Allergy Asthma Immunol 2023; 131(6):752-8.e1. Medline
|
II
|
Supportive (Green)
|
Progression to Anaphylaxis
|
Patient
|
ED-MD
|
Kawano T., Scheuermeyer FX., Gibo K., Stenstrom R., Rowe B., Grafstein E., et al. H1-antihistamines Reduce Progression to Anaphylaxis Among Emergency Department Patients With Allergic Reactions. Academic emergency medicine 2017; 24(6):733-41. Medline
|
Epinephrine
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Description of emergency management
|
Process
|
PH-Paramedic
|
Andrew E., Nehme Z., Bernard S., Smith K. Pediatric Anaphylaxis in the Prehospital Setting: Incidence, Characteristics, and Management. PEC 2018; 22(4):445-51. Medline
|
II
|
Supportive (Green)
|
Adverse events
|
Patient
|
ED-MD
|
Campbell RL, Bellolio MF, Knutson BD, Bellamkonda VR, Fedko MG, Nestler DM, Hess EP. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol Pract. 2015;3(1):76-80 Medline
|
II
|
Supportive (Green)
|
Uncontrolled reactions
|
Patient
|
ED-MD
|
Delli Colli L, Al Ali A, Gabrielli S, et al. Managing anaphylaxis: Epinephrine, antihistamines, and corticosteroids: More than 10 years of Cross-Canada Anaphylaxis REgistry data. Ann Allergy Asthma Immunol 2023; 131(6):752-8.e1. Medline
|
II
|
Supportive (Green)
|
Hospital discharge
|
Patient
|
|
Fleming J., Clark S., Camargo CA J., Rudders S. .Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization. J Allergy Clin Immunol Pract. 2015; (1):57-62. Medline
|
II
|
Supportive (Green)
|
Severity of anaphylaxis symptoms
|
Patient
|
PH-Paramedic
|
Holst Gudichsen J, Aggerholm Bækdal E, Mikkelsen S, et al. Prehospital and In-Hospital Treatment with Adrenaline and Related Prognosis in Anaphylaxis Patients. Int Arch Allergy Immunol. March 2024; 1-10. Medline
|
II
|
Supportive (Green)
|
Development of hypotension during ED stay
|
Patient
|
|
Ko B., Kim J., Seo D. Should adrenaline be used in patients with hemodynamically stable anaphylaxis? Incident case control study nested within a retrospective cohort study. Sci Rep 2016; 6:20168. Medline
|
II
|
Supportive (Green)
|
Biphasic reactions
|
Process
|
ED-MD
|
Liu X., Lee S., Lohse CM., Hardy CT., Campbell RL. Biphasic Reactions in Emergency Department Anaphylaxis Patients: A Prospective Cohort Study. The journal of allergy and clinical immunology In practice 2019. Medline
|
III
|
Supportive (Green)
|
Recovery
|
Patient
|
ED-MD
|
Brown SGA., Blackman KE., Stenlake V., Heddle RJ. Insect sting anaphylaxis; prospective evaluation of treatment with intravenous adrenaline and volume resuscitation. Emerg Med J 2004; 21:149-54. Medline
|
III
|
Supportive (Green)
|
Clinical benefit
|
Patient
|
PH-Paramedic
|
Fortenberry JE., Laine J., Shalit M. Use of epinephrine for anaphylaxis by emergency medical technicians in a wilderness setting. Ann Emerg Med 1995; 25(6):785-7. Medline
|
III
|
Supportive (Green)
|
Recognition and management
|
Process
|
PH-Paramedic
|
Lindbeck GH., Burns DM., Rockwell DD. Out-of-hospital provider use of epinephrine for allergic reactions: Pilot program. Acad Emerg Med 1995; 2(7):592-6. Medline
|
III
|
Supportive (Green)
|
Adverse Events
|
Patient
|
PH-Paramedic
|
Safdar B., Cone DC., Pham KT. Subcutaneous epinephrine in the prehospital setting. Prehosp Emerg Care 2001; 5(2):200-7. Medline
|
III
|
Supportive (Green)
|
Peak plasma concentration of epinephrine
|
Process
|
|
Simons F., Gu X., Simons K. Epinephrine absorption in adults: intramuscular versus subcutaneous injection. J Allergy Clin Immunol 2001; 108(5):871-3. Medline
|