World allergy organization anaphylaxis guidance 2020

World Allergy Organ J. 2020 Oct 30;13(10):100472. doi: 10.1016/j.waojou.2020.100472. eCollection 2020 Oct.


Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions. The occurrence of anaphylaxis has increased in recent years, and subsequently, there is a need to continue disseminating knowledge on the diagnosis and management, so every healthcare professional is prepared to deal with such emergencies. The rationale of this updated position document is the need to keep guidance aligned with the current state of the art of knowledge in anaphylaxis management. The World Allergy Organization (WAO) anaphylaxis guidelines were published in 2011, and the current guidance adopts their major indications, incorporating some novel changes. Intramuscular epinephrine (adrenaline) continues to be the first-line treatment for anaphylaxis. Nevertheless, its use remains suboptimal. After an anaphylaxis occurrence, patients should be referred to a specialist to assess the potential cause and to be educated on prevention of recurrences and self-management. The limited availability of epinephrine auto-injectors remains a major problem in many countries, as well as their affordability for some patients.

Keywords: ACE, Angiotensin converting enzyme; Acute systemic allergic reaction; Adrenaline; Anaphylaxis; Antihistamines; BAT, basophil activation test; CAST, cellular allergen stimulation test; Cofactors; Drug allergy; EAI, epinephrine auto-injectors; Epinephrine; FcεRI, IgE high-affinity receptor; Food allergy; Glucocorticoids; Guidance; Guidelines; IgE, immunoglobulin E; IgG, immunoglobulin G; MRGPRX2, Mas-related G-protein coupled receptor member X2; NSAIDs, nonsteroidal anti-inflammatory drugs; Venom allergy.