Second Symposium on the Definition and Management of Anaphylaxis: Summary Report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium

Johns Hopkins University, Baltimore, Maryland, United States
Annals of emergency medicine (Impact Factor: 4.68). 05/2006; 47(4):373-80. DOI: 10.1016/j.annemergmed.2006.01.018
Source: PubMed


There is no universal agreement on the definition of anaphylaxis or the criteria for diagnosis. In July 2005, the National Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network convened a second meeting on anaphylaxis, which included representatives from 16 different organizations or government bodies, including representatives from North America, Europe, and Australia, to continue working toward a universally accepted definition of anaphylaxis, establish clinical criteria that would accurately identify cases of anaphylaxis with high precision, further review the evidence on the most appropriate management of anaphylaxis, and outline the research needs in this area.

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Available from: Lawrence M Lewis, Jan 28, 2014
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    • "Anaphylaxis is a severe systemic allergic reaction that is rapid in onset and can potentially result in death [1]. It is triggered by the sudden release of chemical mediators such as histamine and leukotrienes from sensitized mast cells and basophils coated with immunoglobulin E antibodies, cumulating in a type 1 hypersensitivity reaction. "
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    ABSTRACT: BackgroundAnaphylaxis is an emergency condition that requires immediate, accurate diagnosis and appropriate management. However, little is known about the level of knowledge of doctors and nurses treating these patients in the Emergency Department.ObjectiveTo determine the knowledge of doctors and nurses in the Emergency Department on the recent definition and treatment recommendations of anaphylaxis.MethodsWe surveyed doctors and nurses of all grades in a tertiary Hospital Emergency Department using a standardized anonymous questionnaire.ResultsWe had a total of 190 respondents-47 doctors and 143 nurses. The response rate was 79.7% for doctors and 75.3% for nurses. Ninety-seven point eight percent of the doctors and 83.7% of the nurses chose the accepted definition of anaphylaxis. High proportions of doctors (89-94%) and nurses (65-72%) diagnose anaphylaxis in the three scenarios demonstrating anaphylaxis and anaphylactic shock. Forty-two point six percent of the doctors and 76.9% of the nurses incorrectly diagnosed single organ involvement without hypotension as anaphylaxis. As for treatment, 89.4% of the doctors indicated adrenaline as the drug of choice and 85.1% chose intramuscular route for adrenaline administration. Among the nurses, 40.3% indicated adrenaline as the drug of choice and 47.4% chose the intramuscular route for adrenaline.ConclusionHigh proportion of doctors and nurses are able to recognize the signs and symptoms of anaphylaxis, although there is a trend towards over diagnosis. There is good knowledge on drug of choice and the accepted route of adrenaline among the doctors. However, knowledge of treatment of anaphylaxis among nurses was moderate and can be improved.
    07/2014; 4(3):164-71. DOI:10.5415/apallergy.2014.4.3.164
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    • "We classified the reported symptoms according to the affected organs: 1) reactions on skin, mucosal tissue or both, such as an urticaria, rash, itching, redness, and angioedema; 2) gastrointestinal symptoms if the reactions involved vomiting, nausea, abdominal pain, or diarrhea; and 3) respiratory symptoms such as cough, dyspnea, and wheezing.9 Anaphylaxis was defined as symptoms that developed rapidly after exposure and affected at least 2 major organs.9 "
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    ABSTRACT: There are scanty epidemiologic data on the prevalence of food allergy (FA) among preschool children in Asia. We performed this study to determine the prevalence and causative foods of immediate-type FA in early childhood in Korea. A questionnaire-based, cross-sectional study was performed between September and October 2011. Children aged 0-6 years were recruited from 301 public child care centers in Seoul. Parents were asked to complete a questionnaire on FA. Children with FA were classified into "perceived FA, ever," "immediate-type FA, ever," and "immediate-type FA, current" according to the algorithm. A total of 16,749 children were included in this study. The prevalence of "perceived FA, ever," "immediate-type FA, ever," and "immediate-type FA, current" was 15.1%, 7.0%, and 3.7%, respectively. "Immediate-type FA, current" was reported by 182 (4.9%) out of 3,738 children aged ≤2 years, 262 (3.4%) of 7,648 children aged 3-4 years, and 177 (3.3%) of 5,363 children aged 5-6 years. Hen's egg (126/621) was the most frequent cause as the individual food item, followed by cow's milk (82/621) and peanut (58/621). Among the food groups, fruits (114/621), tree nuts (90/621) and crustaceans (85/621) were the most common offending foods. The three leading causes of food-induced anaphylaxis were hen's egg (22/47), cow's milk (15/47), and peanut (14/47). The prevalence of immediate-type FA in early childhood is 3.7%, and is higher in younger children. The most common offending foods differed with age.
    Allergy, asthma & immunology research 03/2014; 6(2):131-6. DOI:10.4168/aair.2014.6.2.131 · 2.43 Impact Factor
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    • "Medications were administered immediately on detection of an allergic reaction, and the decision to administer was based on clinical judgment. The reactions for which epinephrine was given were based on current clinical definition of anaphylaxis [13]. Although multisystemic reactions in an outpatient setting should be treated with epinephrine [11,14], in a hospital setting under the supervision of an expert physician treating allergic reactions, epinephrine is used with more stringent criteria of anaphylaxis [13,15,16]. "
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    ABSTRACT: Wheat allergy is among the most common food allergy in children, but few publications are available assessing the risk of anaphylaxis due to wheat. In this study, we report the case of near-fatal anaphylaxis to wheat in a patient undergoing an oral food challenge (OFC) after the ingestion of a low dose (256 mg) of wheat. Moreover, for the first time, we analyzed the risk of anaphylaxis during an OFC to wheat in 93 children, compared to other more commonly challenged foods such as milk, egg, peanuts, and soy in more than 1000 patients. This study, which includes a large number of OFCs to wheat, shows that wheat is an independent risk factor that is associated with anaphylaxis requiring epinephrine administration (Odds Ratio [OR] = 2.4) and anaphylaxis requiring epinephrine administration to low dose antigen (OR = 8.02). Other risk factors for anaphylaxis, anaphylaxis requiring epinephrine administration, and anaphylaxis to low dose antigen was a history of a prior reaction not involving only the skin (OR = 1.8, 1.9 and 1.8 respectively). None of the clinical variables available prior to performing the OFC could predict which children among those undergoing OFCs to wheat would develop anaphylaxis or anaphylaxis for low dose antigen. This study shows that wheat is an independent risk factor that is associated with anaphylaxis requiring epinephrine administration and anaphylaxis requiring epinephrine administration to low dose antigen.
    World Allergy Organization Journal 08/2013; 6(1):14. DOI:10.1186/1939-4551-6-14
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