Revisión sistemática

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Quality indicators for the acute and long-term management of anaphylaxis: a systematic review.

Año 2017
Revista Clinical and translational allergy
Enlaces DOI , PMC , Pubmed

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BACKGROUND:

The quality of acute and long-term anaphylaxis management is variable and this contributes to the poor outcomes experienced by many patients. Clinical practice guidelines have the potential to improve outcomes, but implementing guideline recommendations in routine practice is challenging. Quality indicators have the potential to support guideline implementation efforts.

OBJECTIVE:

To identify quality indicators to support the acute and long-term management of anaphylaxis.

METHODS:

We conducted a systematic review of the literature that involved searching Medline, EMBASE and CINAHL databases for peer-reviewed published literature for the period 1 January 2005-31 December 2015. Additionally we searched Google for grey and unpublished literature. The identified indicators were descriptively summarized against the most recent international anaphylaxis guidelines (i.e. those produced by the European Academy of Allergy and Clinical Immunology) and critically evaluated using the Agency for Healthcare Research and Quality's criteria for indicator development.

RESULTS:

Our searches revealed 830 publications, from which we identified five sources for 54 indicators addressing both acute (n = 27) and long-term (n = 27) management of anaphylaxis. The majority of indicators were developed through expert consensus with relatively few of these having been formally piloted or tested to demonstrate that they could discriminate between variations in practice and/or that they were sensitive to change.

CONCLUSIONS:

There is a need for a comprehensive set of quality indicators for anaphylaxis management. We have however identified some indicators for the acute and long-term management of anaphylaxis that could with relatively little additional work support efforts to translate guideline recommendations into clinical care.

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Revisión sistemática

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Qualitative Research in Teen Experiences Living with Food-Induced Anaphylaxis: A Meta-Aggregation.

Año 2017
Autores Johnson SF , Woodgate RL
Revista Journal of advanced nursing
Enlaces DOI , Pubmed

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AIM:

To describe the central experiences of teens living with Food-Induced Anaphylaxis as a first step in responding to health care needs in this population.

BACKGROUND:

As prevalence of allergy increases and commonly-outgrown allergies persist longer, chronic management for teens becomes increasingly important. This review seeks to understand how teens experience living with Food-Induced Anaphylaxis.

DESIGN:

Meta-aggregation for qualitative systematic review, to create synthesis for clinical improvement; guided by Joanna Briggs Institute methods and their Qualitative Assessment and Review Instrument.

DATA SOURCES:

Seven relevant databases were searched for original qualitative research July 2015; 10 studies (published 2007-2015) met inclusion criteria.

REVIEW METHODS:

Both authors undertook critical appraisal, with consensus by discussion. Findings from line-by-line extraction were grouped into categories and syntheses. In studies with mixed populations, we included only teens (age 12-19) with Food-Induced Anaphylaxis.

RESULTS:

We developed three syntheses from nine categories and 64 subcategories to reflect central experiences of teens with Food-Induced Anaphylaxis, including: (1) Defining the allergic self,;(2) Finding a balance; and (3) Controlling the uncontrollable. The syntheses encompass importance of allergic identity/understanding, difficulties in coping with burdens of food allergy and reflect the complex risk interactions teens must negotiate in social contexts.

CONCLUSION:

There is a need to respect teens as active participants in managing Food-Induced Anaphylaxis, while recognizing that social expectations and a lack of public awareness/safety can dangerously affect one's needs and decisions. This helps broaden how we conceptualize the needs of teens living with Food-Induced Anaphylaxis, informing ongoing care and management. This article is protected by copyright. All rights reserved.

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Resumen estructurado de revisiones sistemáticas

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Adrenaline for the treatment of anaphylaxis: Cochrane systematic review

Año 2009
Autores Sheikh A , Shehata YA , Brown SG , Simons FE
Revista Database of Abstracts of Reviews of Effects (DARE)
Enlaces

Este artículo incluye 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

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Síntesis amplia / Guía

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EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy.

Año 2014
Revista Allergy
Enlaces DOI , Pubmed

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Food allergy can have significant effects on morbidity and quality of life and can be costly in terms of medical visits and treatments. There is therefore considerable interest in generating efficient approaches that may reduce the risk of developing food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Prevention and is part of the EAACI Guidelines for Food Allergy and Anaphylaxis. It aims to provide evidence-based recommendations for primary prevention of food allergy. A wide range of antenatal, perinatal, neonatal, and childhood strategies were identified and their effectiveness assessed and synthesized in a systematic review. Based on this evidence, families can be provided with evidence-based advice about preventing food allergy, particularly for infants at high risk for development of allergic disease. The advice for all mothers includes a normal diet without restrictions during pregnancy and lactation. For all infants, exclusive breastfeeding is recommended for at least first 4-6 months of life. If breastfeeding is insufficient or not possible, infants at high-risk can be recommended a hypoallergenic formula with a documented preventive effect for the first 4 months. There is no need to avoid introducing complementary foods beyond 4 months, and currently, the evidence does not justify recommendations about either withholding or encouraging exposure to potentially allergenic foods after 4 months once weaning has commenced, irrespective of atopic heredity. There is no evidence to support the use of prebiotics or probiotics for food allergy prevention.

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Estudio primario

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A critical incident report: Propofol triggered anaphylaxis.

Año 2011
Autores Koul A , Jain R , Sood J
Revista Indian journal of anaesthesia
Enlaces DOI , Pubmed

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Although propofol is one of the most commonly used drugs for induction of anaesthesia, it is not devoid of anaphylactic potential. Early detection of any suspected anaphylactic reaction during anaesthesia, prompt management, identification of the offending agent and prevention of exposure to the offending agent in the future is the responsibility of the anaesthesiologist. This is a case report of anaphylaxis to propofol at the induction of anaesthesia in a previously non-allergic 56 year-old man, planned to undergo laparoscopic nephrectomy, who responded to epinephrine infusion.

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Resumen estructurado de revisiones sistemáticas

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Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review

Año 2011
Autores Choo KJ , Simons E , Sheikh A
Revista Database of Abstracts of Reviews of Effects (DARE)
Enlaces
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Revisión sistemática

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Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature.

Año 2010
Autores Kastner M , Harada L , Waserman S
Revista Allergy
Enlaces DOI , Pubmed

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Diagnosis and management of anaphylaxis can be a challenge because reactions are often unexpected and progress quickly. The focus of anaphylaxis management has mostly been on the acute episode, with little attention given to the long-term management of patients at risk. This is compounded by conflicting information in current guidelines and a general lack of agreement among clinicians about which management strategies are the most appropriate. We systematically reviewed the literature to identify and summarize studies that investigated gaps in anaphylaxis management. Our search included MEDLINE, EMBASE, CINAHL, and Evidence-Based Medicine Reviews. Studies were included if they addressed an outcome describing gaps in anaphylaxis knowledge, education, anaphylaxis management, and quality of life (QOL). Populations of interest were health care professionals involved in the care of patients at risk for anaphylaxis, and patients of any age, their parents, caregivers, and teachers in primary care, hospital or community settings. Of 5014 citations that were identified, the final 59 studies (selected from 75 full-text articles) met the inclusion criteria. Two hundred and two gaps were identified and classified according to major themes: gaps in knowledge and anaphylaxis management (physicians and patients); gaps in follow-up care (physicians); and QOL of patients and caregivers. Findings from this systematic review revealed gaps in anaphylaxis management at the level of physicians, patients, and the community. Findings will be used to provide a basis for developing interventional strategies to help address these deficiencies.

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Revisión sistemática

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Incidence of food anaphylaxis in people with food allergy: a systematic review and meta-analysis.

Año 2015
Revista Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
Enlaces DOI , Pubmed
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BACKGROUND:

Food allergy is a common cause of anaphylaxis, but the incidence of anaphylaxis in food allergic people is unknown.

METHODS:

We undertook a systematic review and meta-analysis, using the inverse variance method. Two authors selected studies by consensus, independently extracted data and assessed study quality using the Newcastle-Ottawa assessment scale. We searched Medline, Embase, PsychInfo, CINAHL, Web of Science, LILACS and AMED between January 1946 and September 2012, and recent conference abstracts. We included registries, databases or cohort studies which described the number of food anaphylaxis cases in a defined population and time period, and applied an assumed population prevalence of food allergy.

RESULTS:

We included data from 34 studies. There was high heterogeneity between study results, possibly due to variation in study populations, anaphylaxis definition and data collection methods. In food allergic people, medically-coded food anaphylaxis had an incidence rate of 0.14 per 100 person years (95% CI 0.05, 0.35; range 0.01, 1.28). In sensitivity analysis using different estimated food allergy prevalence, the incidence varied from 0.11 to 0.21 per 100 person years. At age 0-19 the incidence rate for anaphylaxis in food allergic people was 0.20 (95%CI 0.09, 0.43; range 0.01, 2.55; sensitivity analysis 0.08, 0.39). At age 0-4 an incidence rate of up to 7.00 per 100 person years has been reported. In food allergic people, hospital admission due to food anaphylaxis had an incidence rate of 0.09 (95% CI 0.01, 0.67; range 0.02, 0.81) per 1000 person years; 0.20 (95% CI 0.10, 0.43; range 0.04, 2.25) at age 0-19 and 0.50 (0.26, 0.93; range 0.08, 2.82) at age 0-4.

CONCLUSION:

In food allergic people, the incidence of food allergic reactions which are coded as anaphylaxis by healthcare systems is low at all ages, but appears to be highest in young children. This article is protected by copyright. All rights reserved.

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Estudio primario

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Serious shortcomings in the management of children with anaphylaxis in Scottish schools.

Año 2006
Autores Rankin KE , Sheikh A
Revista PLoS medicine
Enlaces DOI , Pubmed
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BACKGROUND:

The United Kingdom incidence of anaphylaxis has increased very sharply over the last decade, with the highest rates of hospital admissions occurring in school-aged children. This raises concerns about the extent to which schools are aware of approaches to the prevention and treatment of anaphylaxis.

METHODS AND FINDINGS:

We undertook a national postal survey of 250 Scottish schools enquiring about approaches to managing children considered to be at risk of anaphylaxis. We obtained responses from 148 (60%) schools, 90 (61%) of which reported having at least one at risk child. Most (80%) schools with children considered to be at risk reported having personalised care plans and invariably reported having at least one member of staff trained in the emergency treatment of anaphylaxis. Access to adrenaline was available on-site in 97% of these schools. However, significantly fewer schools without children considered to be at risk reported having a trained member of staff (48%, p < 0.001), with access to adrenaline being very poor (12%, p < 0.001). Overall, 59% of respondents did not feel confident in their school's ability to respond in an emergency situation.

CONCLUSIONS:

Most schools with children considered to be at risk of anaphylaxis report using personal care plans and having a member of staff trained in the use of, and with access to, adrenaline. The picture is, however, less encouraging in schools without known at risk children, both in relation to staff training and access to adrenaline. The majority of schools with at risk children have poorly developed strategies for preventing food-triggered anaphylaxis reactions. There is a need for detailed national guidelines for all schools, which the Scottish Executive must now ensure are developed and implemented.

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Estudio primario

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Anafilaxia oral por alimentos contaminados por ácaros: (síndrome de las panquecas)

Traducción oficial
Año 2011
Revista Gac. méd. Caracas
Enlaces Virtual Health Library
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La anafilaxia oral por ácaros es un nuevo síndrome caracterizado por síntomas alérgicos graves que se presentan en individuos alérgicos rápidamente después de la ingestion de alimentos confeccionados con harinas de trigo contaminadas con ácaros. Este síndrome más común en ambientes tropicales, es desencadenado más frecuentemente por panquecas y por ello ha sido designado "el síndrome de las panquecas". Se postula que los alergenos responsables son alergenos termorresistentes ya que los alimentos cocinados son capaces de inducir los síntomas. Una variedad del síndrome puede presentarse durante el ejercicio físico (anafilaxia inducida por ejercicio asociada a la ingestión de polvo con ácaros). Se recomienda conservar las harinas de trigo en el refrigerador para prevenir la proliferación de los ácaros y la aparición del cuadro clínico.

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