Practice parameter
Emergency department diagnosis and treatment of anaphylaxis: a practice parameter

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StatementDefinitionImplication
Strong recommendationA strong recommendation means the benefits of the recommended approach clearly exceed the harms (or that the harms clearly exceed the benefits in the case of a strong negative recommendation) and that the quality of the supporting evidence is excellent (grade A or B)*. In some clearly identified circumstances, strong recommendations may be made based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated

The Joint Task Force on Practice Parameters

The Joint Task Force on Practice Parameters is a 13-member task force consisting of 6 representatives assigned by the American Academy of Allergy, Asthma and Immunology; 6 by the American College of Allergy, Asthma and Immunology; and 1 by the Joint Council of Allergy and Immunology. This task force oversees the development of practice parameters; selects the workgroup chair(s); and reviews drafts of the parameters for accuracy, practicality, clarity, and broad utility of the recommendations

Preface

This practice parameter is a joint effort between emergency physicians, who are often on the front line in the management of anaphylaxis, and allergists-immunologists, who have a vested interest in how such patients are managed. As recognized by emergency physicians and allergists, the timely administration of epinephrine is essential to the effective treatment of anaphylaxis, and such administration is dependent on correctly diagnosing anaphylaxis. In an emergency department (ED) setting, with

Compilation of summary statements

  • Summary Statement 1: Base the diagnosis of anaphylaxis on the history and physical examination, using scenarios described by the National Institutes of Allergy and Infectious Disease (NIAID) Panel (Fig 1)8 but recognizing that there is a broad spectrum of anaphylaxis presentations that require clinical judgment. Do not rely on signs of shock for the diagnosis of anaphylaxis. (Strong Recommendation; C Evidence)

  • Summary Statement 2: Carefully and immediately triage and monitor patients with signs

ED diagnosis and management of anaphylaxis: a practice parameter

  • Summary Statement 1: Base the diagnosis of anaphylaxis on the history and physical examination, using scenarios described by the NIAID Panel (Fig 1) but recognizing that there is a broad spectrum of anaphylaxis presentations that require clinical judgment. Do not rely on signs of shock for the diagnosis of anaphylaxis. (Moderate Recommendation; C Evidence)

Symptoms of anaphylaxis are usually sudden in onset and can progress in severity over minutes to hours. Typically, at least 2 organ systems

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    Members of the Joint Task Force: David Bernstein, MD; Joann Blessing-Moore, MD; David Khan, MD; David Lang, MD; Richard Nicklas, MD; John Oppenheimer, MD; Jay Portnoy, MD; Christopher Randolph, MD; Diane Schuller, MD; Sheldon Spector, MD; Stephen Tilles, MD; Dana Wallace, MD

    Practice Parameter Workgroup: Ronna L. Campbell, MD, PhD; James T.C. Li, MD, PhD; Annie T. Sadosty, MD

    This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.

    Disclaimer: The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing “Emergency Department Diagnosis and Treatment of Anaphylaxis.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.

    Reprints: Joint Council of Allergy, Asthma and Immunology, 50 N Brockway Street, #3-3, Palatine, IL 60067.

    Published practice parameters of the Joint Task Force on Practice Parameters for Allergy and Immunology are available online at http://www.jcaai.org and http://www.allergyparameters.org.

    Disclosures: The Joint Task Force recognizes that experts in a field are likely to have interests that could come into conflict with development of a completely unbiased and objective practice parameter. To take advantage of that expertise, a process has been developed to prevent potential conflicts from influencing the final document in a negative way. At the workgroup level, members who have a potential conflict of interest do not participate in discussions concerning topics related to the potential conflict, or if they do write a section on that topic, the workgroup completely rewrites it without their involvement to remove potential bias. In addition, the entire document is reviewed by the Joint Task Force and any apparent bias is removed at that level. The practice parameter is sent for review by invited reviewers and by anyone with an interest in the topic by posting the document on the Web sites of the ACAAI and the AAAAI.

    Contributors: The Joint Task Force has made a concerted effort to acknowledge all contributors to this parameter. If any contributors have been excluded inadvertently, the Joint Task Force will ensure that appropriate recognition of such contributions is made subsequently.

    Workgroup Chairs, Ronna L. Campbell, MD, PhD; James T. Li, MD, PhD; Joint Task Force Liaison, Richard A. Nicklas, MD, Clinical Professor of Medicine, George Washington Medical Center, Washington, DC; Joint Task Force Members, David I. Bernstein, MD, Professor of Clinical Medicine and Environmental Health, Division of Allergy/Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Joann Blessing-Moore, MD, Adjunct Professor of Medicine and Pediatrics, Stanford University Medical Center, Department of Immunology, Palo Alto, California; David A. Khan, MD, Associate Professor of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; David M. Lang, MD, Head, Allergy/Immunology Section, Division of Medicine, Director, Allergy and Immunology Fellowship Training Program, Cleveland Clinic Foundation, Cleveland, Ohio; Richard A. Nicklas, MD, Clinical Professor of Medicine, George Washington Medical Center, Washington, DC; John Oppenheimer, MD, Department of Internal Medicine, New Jersey Medical School, Pulmonary and Allergy Associates, Morristown, New Jersey; Jay M. Portnoy, MD, Chief, Section of Allergy, Asthma & Immunology, The Children's Mercy Hospital, Professor of Pediatrics, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri; Christopher C. Randolph, MD, Clinical Professor of Pediatrics, Yale Affiliated Hospitals, Center for Allergy, Asthma, & Immunology, Waterbury, Connecticut; Diane E. Schuller, MD, Professor of Pediatrics, Pennsylvania State University Milton S. Hershey Medical College, Hershey, Pennsylvania; Sheldon L. Spector, MD, Clinical Professor of Medicine, UCLA School of Medicine, Los Angeles, California; Stephen A. Tilles, MD, Clinical Professor of Medicine, University of Washington School of Medicine, Redmond, Washington; Dana Wallace, MD, Assistant Clinical Professor of Medicine, Nova Southeastern University College of Osteopathic Medicine, Davie, Florida; Parameter Workgroup Member, Annie T. Sadosty, MD; Assigned Reviewers: Estelle Simons, MD, Winnepeg, Manitoba, Canada; Marcella Aquino, MD, Mineola, New York.

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