Evaluation of national institute of allergy and infectious diseases/food allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients

J Allergy Clin Immunol. 2012 Mar;129(3):748-52. doi: 10.1016/j.jaci.2011.09.030. Epub 2011 Nov 1.


Background: Diagnostic criteria were proposed at the Second Symposium on the Definition and Management of Anaphylaxis convened by the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN). Validation is needed before these criteria can be widely adapted into clinical practice.

Objective: Our aim was to retrospectively assess the diagnostic accuracy of the NIAID/FAAN criteria for the diagnosis of anaphylaxis in emergency department (ED) patients.

Methods: A retrospective cohort study of ED patients presenting from April to October 2008 was conducted. Patients given a diagnosis of an allergic reaction or anaphylaxis and a subset of patients with related diagnoses were included. Electronic medical records were reviewed and data were abstracted to determine whether the NIAID/FAAN criteria were met. Records were also independently reviewed in a blinded fashion by 2 experienced attending allergists. Final diagnosis by allergists was considered the reference standard.

Results: Of 214 patients, 86 (40.2%) met the NIAID/FAAN criteria for anaphylaxis. Allergists gave 61 (28.5%) patients diagnoses of anaphylaxis, 59 (96.7%) of whom satisfied the NIAID/FAAN criteria. The interrater agreement between allergists was substantial (κ = 0.77). The test characteristics of the NIAID/FAAN criteria were as follows: sensitivity, 96.7% (95% CI, 88.8% to 99.1%); specificity, 82.4% (95% CI, 75.5% to 87.6%); positive predictive value, 68.6% (95% CI, 58.2% to 77.4%); negative predictive value, 98.4% (95% CI, 94.5% to 99.6%); positive likelihood ratio, 5.48; and negative likelihood ratio, 0.04.

Conclusions: These results suggest that the NIAID/FAAN criteria are highly sensitive but less specific and are likely to be useful in the ED for the diagnosis of anaphylaxis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anaphylaxis / diagnosis*
  • Anaphylaxis / epidemiology
  • Anaphylaxis / etiology
  • Cohort Studies
  • Diagnosis, Differential
  • Electronic Health Records / statistics & numerical data
  • Emergency Medical Services
  • Female
  • Food Hypersensitivity / complications
  • Food Hypersensitivity / diagnosis*
  • Food Hypersensitivity / epidemiology
  • Humans
  • Male
  • Middle Aged
  • National Institute of Allergy and Infectious Diseases (U.S.)
  • Practice Guidelines as Topic*
  • Predictive Value of Tests
  • Retrospective Studies
  • Sensitivity and Specificity
  • United States