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Anaphylaxis

Date Last Search Run: Feb 01, 2022
Table last updated: May 02, 2021
Data last added: Mar 31, 2021

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)    
3 (weak evidence exists)    


Interventions

Beta Agonist-Nebulized
Level Direction Primary Outcome Patient/Process Setting Reference

Crystalloid Infusion
Level Direction Primary Outcome Patient/Process Setting Reference
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

Diphenhydramine
Level Direction Primary Outcome Patient/Process Setting Reference
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

Dopamine Infusion
Level Direction Primary Outcome Patient/Process Setting Reference

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) 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) 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

Glucagon
Level Direction Primary Outcome Patient/Process Setting Reference

H2 Blocker with Diphenhydramine
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Resolution of symptoms Patient ED-MD Lin Y., et al. Improved outcomes in patients with acute allergic syndromes who are treated with combined H1 and H2 antagonists. Ann Emerg Med 2000; 36:462 Medline

Intubation
Level Direction Primary Outcome Patient/Process Setting Reference

Steroid
Level Direction Primary Outcome Patient/Process Setting Reference


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