EAACI guidelines: Anaphylaxis (2021 update)

doi:10.1111/all.15032

Practice Guideline

. 2022 Feb;77(2):357-377.

doi: 10.1111/all.15032. Epub 2021 Sep 1.

EAACI guidelines: Anaphylaxis (2021 update)

Antonella Muraro¹, Margitta Worm², Cherry Alviani³, Victoria Cardona⁴, Audrey DunnGalvin^{5

6}, Lene Heise Garvey^{7

8}, Carmen Riggioni⁹, Debra de Silva¹⁰, Elizabeth Angier¹¹, Stefania Arasi¹², Abdelouahab Bellou^{13

14

15}, Kirsten Beyer¹⁶, Diola Bijlhout¹⁷, Maria Beatrice Bilò^{18

19}, Carsten Bindslev-Jensen²⁰, Knut Brockow²¹, Montserrat Fernandez-Rivas²², Susanne Halken²³, Britt Jensen²⁰, Ekaterina Khaleva³, Louise J Michaelis^{24

25}, Hanneke N G Oude Elberink²⁶, Lynne Regent²⁷, Angel Sanchez²⁸, Berber J Vlieg-Boerstra²⁹, Graham Roberts^{3

30

31}; European Academy of Allergy and Clinical Immunology, Food Allergy, Anaphylaxis Guidelines Group

Affiliations

¹ Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy.
² Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin Berlin, Germany.
³ Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, UK.
⁴ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain.
⁵ University College Cork, Cork, Ireland.
⁶ Sechnov University Moscow, Moscow, Russia.
⁷ Allergy Clinic, Department of Dermatology and allergy, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
⁸ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁹ Allergy, Immunology and Rheumatology Division, Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.
¹⁰ The Evidence Centre Ltd, London, UK.
¹¹ Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
¹² Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹³ European Society for Emergency Medicine, Brussels, Belgium.
¹⁴ Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
¹⁵ University of Rennes 1, Rennes, France.
¹⁶ Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁷ Association for Teacher Education in Europe (ATEE, Brussels, Belgium.
¹⁸ Allergy Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
¹⁹ Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy.
²⁰ Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark.
²¹ Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany.
²² Allergy Department, Hospital Clinico San Carlos, Facultad Medicina Universidad Complutense, IdISSC, ARADyAL, Madrid, Spain.
²³ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
²⁴ Department of Paediatric Immunology, Allergy, and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK.
²⁵ Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
²⁶ Department of Allergology, University Medical Center Groningen, University of Groningen, and Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands.
²⁷ Anaphylaxis Campaign, Farnborough, UK.
²⁸ AEPNAA Spanish Association for People with Food and Latex Allergy, Madrid, Spain.
²⁹ Department of Paediatrics, OLVG Hospital, Amsterdam, The Netherlands.
³⁰ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
³¹ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.

PMID: 34343358
DOI: 10.1111/all.15032

Practice Guideline

EAACI guidelines: Anaphylaxis (2021 update)

Antonella Muraro et al. Allergy. 2022 Feb.

. 2022 Feb;77(2):357-377.

doi: 10.1111/all.15032. Epub 2021 Sep 1.

Authors

Affiliations

¹ Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy.
² Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin Berlin, Germany.
³ Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, UK.
⁴ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain.
⁵ University College Cork, Cork, Ireland.
⁶ Sechnov University Moscow, Moscow, Russia.
⁷ Allergy Clinic, Department of Dermatology and allergy, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
⁸ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁹ Allergy, Immunology and Rheumatology Division, Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.
¹⁰ The Evidence Centre Ltd, London, UK.
¹¹ Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
¹² Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹³ European Society for Emergency Medicine, Brussels, Belgium.
¹⁴ Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
¹⁵ University of Rennes 1, Rennes, France.
¹⁶ Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁷ Association for Teacher Education in Europe (ATEE, Brussels, Belgium.
¹⁸ Allergy Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
¹⁹ Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy.
²⁰ Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark.
²¹ Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany.
²² Allergy Department, Hospital Clinico San Carlos, Facultad Medicina Universidad Complutense, IdISSC, ARADyAL, Madrid, Spain.
²³ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
²⁴ Department of Paediatric Immunology, Allergy, and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK.
²⁵ Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
²⁶ Department of Allergology, University Medical Center Groningen, University of Groningen, and Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands.
²⁷ Anaphylaxis Campaign, Farnborough, UK.
²⁸ AEPNAA Spanish Association for People with Food and Latex Allergy, Madrid, Spain.
²⁹ Department of Paediatrics, OLVG Hospital, Amsterdam, The Netherlands.
³⁰ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
³¹ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.

PMID: 34343358
DOI: 10.1111/all.15032

Abstract

Anaphylaxis is a clinical emergency which all healthcare professionals need to be able to recognize and manage. The European Academy of Allergy and Clinical Immunology Anaphylaxis multidisciplinary Task Force has updated the 2014 guideline. The guideline was developed using the AGREE II framework and the GRADE approach. The evidence was systematically reviewed and recommendations were created by weighing up benefits and harms. The guideline was peer-reviewed by external experts and reviewed in a public consultation. The use of clinical criteria to identify anaphylaxis is suggested with blood sampling for the later measurement of tryptase. The prompt use of intramuscular adrenaline as first-line management is recommended with the availability of adrenaline autoinjectors to patients in the community. Pharmacokinetic data should be provided for adrenaline autoinjector devices. Structured, comprehensive training for people at risk of anaphylaxis is recommended. Simulation training and visual prompts for healthcare professionals are suggested to improve the management of anaphylaxis. It is suggested that school policies reflect anaphylaxis guidelines. The evidence for the management of anaphylaxis remains mostly at a very low level. There is an urgent need to prioritize clinical trials with the potential to improve the management of patients at risk of anaphylaxis.

Keywords: adults; anaphylaxis; children; guidelines.

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Comment in

Comment on EAACI guideline: Anaphylaxis (2021 update).
Miceli Sopo S, Sinatti D, Mastellone F, Bersani G, Gelsomino M. Miceli Sopo S, et al. Allergy. 2022 Jul;77(7):2268. doi: 10.1111/all.15256. Allergy. 2022. PMID: 35770816 No abstract available.

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References

REFERENCES

1. Simons FE, Ardusso LR, Bilo MB, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7(1):9.
1. Bilo MB, Corsi A, Martini M, Penza E, Grippo F, Bignardi D. Fatal anaphylaxis in Italy: analysis of cause-of-death national data, 2004-2016. Allergy. 2020;75(10):2644-2652.
1. Turner PJ, Gowland MH, Sharma V, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012. J Allergy Clin Immunol. 2015;135(4):956-963.e1.
1. Greenhawt M, Gupta RS, Meadows JA, et al. Guiding principles for the recognition, diagnosis, and management of infants with anaphylaxis: an expert panel consensus. J Allergy Clin Immunol Pract 2019;7(4):1148-1156 e1145.
1. Francuzik W, Ruëff F, Bauer A, et al. Phenotype and risk factors of venom-induced anaphylaxis: a case-control study of the European Anaphylaxis Registry. J Allergy Clin Immunol. 2021;147(2):653-662.e9. https://doi.org/10.1016/j.jaci.2020.06.008. Epub 2020 Jun 22.

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[1] Simons FE, Ardusso LR, Bilo MB, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7(1):9.

[2] Simons FE, Ardusso LR, Bilo MB, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7(1):9.

[3] Bilo MB, Corsi A, Martini M, Penza E, Grippo F, Bignardi D. Fatal anaphylaxis in Italy: analysis of cause-of-death national data, 2004-2016. Allergy. 2020;75(10):2644-2652.

[4] Bilo MB, Corsi A, Martini M, Penza E, Grippo F, Bignardi D. Fatal anaphylaxis in Italy: analysis of cause-of-death national data, 2004-2016. Allergy. 2020;75(10):2644-2652.

[5] Turner PJ, Gowland MH, Sharma V, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012. J Allergy Clin Immunol. 2015;135(4):956-963.e1.

[6] Turner PJ, Gowland MH, Sharma V, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012. J Allergy Clin Immunol. 2015;135(4):956-963.e1.

[7] Greenhawt M, Gupta RS, Meadows JA, et al. Guiding principles for the recognition, diagnosis, and management of infants with anaphylaxis: an expert panel consensus. J Allergy Clin Immunol Pract 2019;7(4):1148-1156 e1145.

[8] Greenhawt M, Gupta RS, Meadows JA, et al. Guiding principles for the recognition, diagnosis, and management of infants with anaphylaxis: an expert panel consensus. J Allergy Clin Immunol Pract 2019;7(4):1148-1156 e1145.

[9] Francuzik W, Ruëff F, Bauer A, et al. Phenotype and risk factors of venom-induced anaphylaxis: a case-control study of the European Anaphylaxis Registry. J Allergy Clin Immunol. 2021;147(2):653-662.e9. https://doi.org/10.1016/j.jaci.2020.06.008. Epub 2020 Jun 22.

[10] Francuzik W, Ruëff F, Bauer A, et al. Phenotype and risk factors of venom-induced anaphylaxis: a case-control study of the European Anaphylaxis Registry. J Allergy Clin Immunol. 2021;147(2):653-662.e9. https://doi.org/10.1016/j.jaci.2020.06.008. Epub 2020 Jun 22.

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EAACI guidelines: Anaphylaxis (2021 update)

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EAACI guidelines: Anaphylaxis (2021 update)

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