Revisión sistemática

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H2-antihistamines for the treatment of anaphylaxis with and without shock: a systematic review.

Año 2014
Revista Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
Enlaces DOI , Pubmed

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BACKGROUND:

Anaphylaxis is a serious allergic or hypersensitivity reaction, which is rapid in onset and sometimes can prove fatal. Although H2-antihistamines are often administered for emergency treatment in anaphylaxis, there is uncertainty about their effectiveness in this disease.

OBJECTIVE:

To assess the benefits and harms of H2-antihistamines in the treatment of anaphylaxis.

METHODS:

A systematic review was performed of randomized controlled trials and quasi-randomized controlled trials comparing H2-antihistamines with placebo or no intervention in patients with anaphylaxis.

RESULTS:

The authors failed to identify any eligible studies for inclusion in this systematic review.

CONCLUSION:

When H2-antihistamines are recommended for anaphylaxis treatment, the status of the evidence base supporting their use should be described. Well-designed randomized controlled trials investigating the role of H2-antihistamines in anaphylaxis treatment are urgently needed.

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Revisión sistemática

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Managing anxiety related to anaphylaxis in childhood: a systematic review.

Año 2012
Autores Manassis K
Revista Journal of allergy
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Objectives. This paper reviews the relationship between anxiety and anaphylaxis in children and youth, and principles for managing anxiety in the anaphylactic child and his or her parents. Methods. A review of the medical literature (Medline) was done using the keywords "anxiety," "anaphylaxis," and "allergy," limited to children and adolescents. Findings were organized into categories used in the treatment of childhood anxiety disorders, then applied to managing anxiety in the anaphylactic child. Results. Twenty-four relevant papers were identified. These varied widely in methodology. Findings emphasized included the need to distinguish anxiety-related and organic symptoms, ameliorate the anxiety-related impact of anaphylaxis on quality of life, and address parental anxiety about the child. Conclusion. Children with anaphylaxis can function well despite anxiety, but the physical, cognitive, and behavioral aspects of anxiety associated with anaphylactic risk must be addressed, and parents must be involved in care in constructive ways.

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Revisión sistemática

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H1-antihistamines for the treatment of anaphylaxis: Cochrane systematic review.

Año 2007
Autores Sheikh A , Ten Broek V , Brown SG , Simons FE
Revista Allergy
Enlaces DOI , Pubmed

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Este artículo está incluido en 1 Resumen estructurado de revisiones sistemáticas 0 Resúmenes estructurados de revisiones sistemáticas (1 referencia)

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BACKGROUND:

Anaphylaxis is an acute systemic allergic reaction, which can be life-threatening. H(1)-antihistamines are commonly used as an adjuvant therapy in the treatment of anaphylaxis. We sought to assess the benefits and harm of H(1)-antihistamines in the treatment of anaphylaxis.

METHODS:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library); MEDLINE (1966 to June 2006); EMBASE (1966 to June 2006); CINAHL (1982 to June 2006) and ISI Web of Science (1945 to July 2006). We also contacted pharmaceutical companies and international experts in anaphylaxis in an attempt to locate unpublished material. Randomized and quasi-randomized-controlled trials comparing H(1)-antihistamines with placebo or no intervention were eligible for inclusion. Two authors independently assessed articles for inclusion.

RESULTS:

We found no studies that satisfied the inclusion criteria.

CONCLUSIONS:

Based on this review, we are unable to make any recommendations for clinical practice. Randomized-controlled trials are needed, although these are likely to prove challenging to design and execute.

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Estudio primario

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The psychosocial impact of anaphylaxis on young people and their parents.

Año 2007
Autores Akeson N , Worth A , Sheikh A
Revista Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
Enlaces DOI , Pubmed

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BACKGROUND:

Anaphylaxis is a potentially life-threatening disorder that can affect people of all ages. Young people are at a disproportionately increased risk of anaphylaxis deaths for reasons that include a failure to institute appropriate long-term management regimens. A pre-requisite for effective supported self-management of young people with anaphylaxis is a better understanding of the factors that contribute to risk-taking behaviour.

OBJECTIVE:

To explore the psychosocial impact of living with anaphylaxis on adolescents and their parents; their management of the condition; and perceptions of health care provision.

METHODS:

In-depth interviews were conducted with 15 participants, these comprising of seven adolescents aged between 13 and 16 years with a history of clinician-diagnosed anaphylaxis and eight of their parents, in this Scottish community-based exploratory qualitative study.

RESULTS:

Adolescents in this study typically perceived anaphylaxis as 'no big deal', describing a relatively low impact on their day-to-day life when compared with their parents. This could largely be explained by the fact that most adolescents could not remember an anaphylactic reaction. Key obstacles to effective long-term self-management included inadequate knowledge to support detailed situation-specific risk assessment, this being compounded by a lack of confidence to make further enquiries about the ingredients of meals when with peers. Parents reported anxiety about 'handing over' the main responsibility for avoidance and emergency management to their children. Medical support for these families was very limited, with primary care teams in some cases actively hindering effective self-management.

CONCLUSION:

Having a child with anaphylaxis can have a significant long-term psychological impact on parents and this anxiety may in some cases be transferred from parents onto their children. Parents and adolescents may benefit from tailored information to support the transition from parental- to self-management by adolescents. Access to appropriate national health service primary and specialist care was in some cases currently inadequate to support effective long-term management. Further, more in-depth research in a more heterogeneous group of adolescents is needed.

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Revisión sistemática

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Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community

Año 2012
Revista Cochrane Database of Systematic Reviews
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Esta revisión no incluye ningún estudio primario

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BACKGROUND:

Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may cause death. Adrenaline (epinephrine) auto-injectors are recommended as the initial, potentially life-saving treatment of choice for anaphylaxis in the community, but they are not universally available and have limitations in their use.

OBJECTIVES:

To assess the effectiveness of adrenaline (epinephrine) auto-injectors in relieving respiratory, cardiovascular, and other symptoms during episodes of anaphylaxis that occur in the community.

SEARCH METHODS:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE (Ovid SP) (1950 to January 2012), EMBASE (Ovid SP) (1980 to January 2012 ), CINAHL (EBSCO host) (1982 to January 2012 ), AMED (EBSCO host) (1985 to January 2012 ), LILACS, (BIREME) (1980 to January 2012 ), ISI Web of Science (1950 to January 2012 ). We adapted our search terms for other databases. We also searched websites listing on-going trials: the World Health Organization International Clinical Trials Registry Platform, the UK Clinical Research Network Study Portfolio, and the meta Register of Controlled Trials; and contacted pharmaceutical companies who manufacture adrenaline auto-injectors in an attempt to locate unpublished material.

SELECTION CRITERIA:

Randomized and quasi-randomized controlled trials comparing auto-injector administration of adrenaline with any control including no intervention, placebo, or other adrenergic agonists were eligible for inclusion.

DATA COLLECTION AND ANALYSIS:

Two authors independently assessed articles for inclusion.

MAIN RESULTS:

None of the 1328 studies that were identified satisfied the inclusion criteria.

AUTHORS' CONCLUSIONS:

Based on this review, we cannot make any new recommendations on the effectiveness of adrenaline auto-injectors for the treatment of anaphylaxis. Although randomized, double-blind, placebo-controlled clinical trials of high methodological quality are necessary to define the true extent of benefits from the administration of adrenaline in anaphylaxis via an auto-injector, such trials are unlikely to be performed in individuals experiencing anaphylaxis because of ethical concerns associated with randomization to placebo. There is, however, a need to consider trials in which, for example, auto-injectors of different doses of adrenaline and differing devices are compared in order to provide greater clarity on the dose and device of choice. Such trials would be practically challenging to conduct. In the absence of appropriate trials, we recommend that adrenaline administration by auto-injector should still be regarded as the most effective first-line treatment for the management of anaphylaxis in the community. In countries where auto-injectors are not commonly used, it may be possible to conduct trials to compare administration of adrenaline via auto-injector with adrenaline administered by syringe and ampoule, or comparing the effectiveness of two different types of auto-injector.

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Estudio primario

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Kounis syndrome resulting from anaphylaxis to diclofenac.

Año 2013
Autores Tiwari AK , Tomar GS , Ganguly CS , Kapoor MC
Revista Indian journal of anaesthesia
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"Kounis syndrome" refers to acute coronary syndromes of varying degree (myocardial ischaemia to infarction) induced by mast cell activation as a result of allergic and anaphylactic reactions. ST-segment elevated myocardial infarction is a rare complication that can occur even in patients with normal coronary arteries due to anaphylactic reactions. We present a case that developed acute myocardial infarction following a diclofenac sodium-induced anaphylaxis. The patient did not have any previous coronary artery disease, but there was a temporal relationship with development of the anaphylactic reaction due to diclofenac sodium and the cardiac event. The patient was managed conservatively and the recovery was uneventful.

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Estudio primario

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Palonosetron induced anaphylaxis in an adult female.

Año 2010
Autores Gupta YK , Shanmugam SP , Padhy BM , Goyal A
Revista British journal of clinical pharmacology
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Revisión sistemática

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Systematic review of outcome measures in trials of pediatric anaphylaxis treatment.

Año 2014
Autores Rubin T , Clayton J , Adams D , Jou H , Vohra S
Revista BMC pediatrics
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BACKGROUND:

Considerable heterogeneity has been observed in the selection and reporting of disease-specific pediatric outcome measures in randomized controlled trials (RCTs). This makes interpretation of results and comparison across trials challenging. Outcome measures in pediatric anaphylaxis trials have never previously been systematically assessed. This systematic review (SR) identified and assessed outcome measures used in RCTs of anaphylaxis treatment in children. As a secondary objective, this SR assessed the evidence for current treatment modalities for anaphylaxis in the pediatric population.

METHODS:

We searched MEDLINE, EMBASE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL from 2001 until December 2012. We also searched websites listing ongoing trials. We included randomized and controlled trials of anaphylaxis treatment in patients 0-18 years of age. Two authors independently assessed articles for inclusion.

RESULTS:

No published studies fulfilled the inclusion criteria.

CONCLUSIONS:

There is an alarming absence of RCTs evaluating the treatments for anaphylaxis in children. High quality studies are needed and are possible to design, despite the severe and acute nature of this condition. Consensus about the selection and validation of appropriate outcome measures will enhance the quality of research and improve the care of children with anaphylaxis.

TRIAL REGISTRATION:

CRD42012002685.

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Revisión sistemática

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Anaphylaxis management before and after implementation of guidelines in the pediatric emergency department.

Año 2015
Revista The journal of allergy and clinical immunology. In practice
Enlaces DOI , Pubmed

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Este artículo no tiene resumen

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Revisión sistemática

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Action plans for the long-term management of anaphylaxis: systematic review of effectiveness.

Año 2007
Autores Choo K , Sheikh A
Revista Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
Enlaces DOI , Pubmed

Esta revisión no incluye ningún estudio primario

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BACKGROUND:

Anaphylaxis is a severe, potentially life-threatening allergic reaction. Most reactions occur in the absence of a healthcare professional and there is a considerable risk of recurrence in those with a past history of anaphylaxis. The concept of action plans has been developed to facilitate long-term self-management of chronic disorders with a view to promoting patient empowerment and improving health outcomes. Although increasingly advocated for use in anaphylaxis, the effectiveness of this approach in this context is unknown.

OBJECTIVES:

To assess the effectiveness of action plans as part of the long-term self-management of anaphylaxis in improving health outcomes.

METHODS:

Standard systematic review techniques were used. We searched CENTRAL, Cochrane, Medline and Embase databases, contacted an international panel of anaphylaxis experts and relevant pharmaceutical companies and searched key web-based databases of trials (http://www.clinicaltrials.gov, http://www.controlledtrials.com and http://www.nrr.nhs.uk) for published, unpublished and on-going randomized or quasi-randomized controlled trials of action plans in anaphylaxis management. There was no restriction used with respect to the language of publication. Searches were completed in summer 2006.

RESULTS:

None of the 1026 potentially relevant studies identified fulfilled the inclusion criteria for this review.

CONCLUSIONS:

Although there are potential major benefits of routinely issuing anaphylaxis action plans, there is currently no robust evidence to guide clinical practice. Pragmatic randomized-controlled trials of anaphylaxis action plans are urgently needed; in the meantime, national and international guidelines should make clear this major gap in the evidence base.

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