Frontiers in Pharmacology (Mar 2022)
A Clinical Practice Guideline for the Emergency Management of Anaphylaxis (2020)
- Xiaotong Li,
- Xiaotong Li,
- Xiaotong Li,
- Qingbian Ma,
- Jia Yin,
- Ya’an Zheng,
- Rongchang Chen,
- Yuguo Chen,
- Tianzuo Li,
- Yuqin Wang,
- Kehu Yang,
- Hongjun Zhang,
- Yida Tang,
- Yaolong Chen,
- Hailong Dong,
- Qinglong Gu,
- Daihong Guo,
- Xuehui Hu,
- Lixin Xie,
- Baohua Li,
- Yuzhen Li,
- Tongyu Lin,
- Fang Liu,
- Zhiqiang Liu,
- Lanting Lyu,
- Lanting Lyu,
- Quanxi Mei,
- Jie Shao,
- Huawen Xin,
- Fan Yang,
- Hui Yang,
- Wanhua Yang,
- Xu Yao,
- Chunshui Yu,
- Siyan Zhan,
- Guoqiang Zhang,
- Minggui Wang,
- Zhu Zhu,
- Baoguo Zhou,
- Jianqing Gu,
- Mo Xian,
- Yuan Lyu,
- Zhengqian Li,
- Hangci Zheng,
- Hangci Zheng,
- Chang Cui,
- Chang Cui,
- Shuhua Deng,
- Chao Huang,
- Lisha Li,
- Pengfei Liu,
- Peng Men,
- Peng Men,
- Chunli Shao,
- Sai Wang,
- Xiang Ma,
- Xiang Ma,
- Qiang Wang,
- Suodi Zhai,
- Suodi Zhai
Affiliations
- Xiaotong Li
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Xiaotong Li
- School of Pharmaceutical Science, Peking University, Beijing, China
- Xiaotong Li
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Qingbian Ma
- Emergency Department, Peking University Third Hospital, Beijing, China
- Jia Yin
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Ya’an Zheng
- Emergency Department, Peking University Third Hospital, Beijing, China
- Rongchang Chen
- State Key Laboratory for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Yuguo Chen
- Department of Emergency Medicine and Chest Pain Center, Qilu Hospital of Shandong University, Institute of Emergency and Critical Care Medicine of Shandong University, Ji’nan, China
- Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Yuqin Wang
- Pharmacy Department, Xuanwu Hospital of Capital Medical University, Beijing, China
- Kehu Yang
- 0Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Hongjun Zhang
- 1Departments of Nursing, Peking University Third Hospital, Beijing, China
- Yida Tang
- 2Department of Internal Medicine, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Yaolong Chen
- 0Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Hailong Dong
- 3Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
- Qinglong Gu
- 4Department of Otolaryngology, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
- Daihong Guo
- 5Pharmacy Department, Chinese PL A General Hospital, Beijing, China
- Xuehui Hu
- 6Department of Nursing, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
- Lixin Xie
- 7Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
- Baohua Li
- 1Departments of Nursing, Peking University Third Hospital, Beijing, China
- Yuzhen Li
- 8Department of Pharmacy, Peking University People’s Hospital, Beijing, China
- Tongyu Lin
- 9State Key Laboratory of Oncology in South China, Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Fang Liu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Zhiqiang Liu
- 0Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- Lanting Lyu
- 1School of Public Administration and Policy, Renmin University of China, Beijing, China
- Lanting Lyu
- 2Health Technology Assessment and Health Policy Research Group at Renmin University of China, Beijing, China
- Quanxi Mei
- 3Department of Pharmacy, Shenzhen Bao’an Pure Chinese Medicine Treatment Hospital, Shenzhen, China
- Jie Shao
- 4Department of Pediatrics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Huawen Xin
- 5Department of Clinical Pharmacology, General Hospital of Central Theater Command of PLA, Wuhan, China
- Fan Yang
- 6Institute of Antibiotics, Huashan Hospital Fudan University, Shanghai, China
- Hui Yang
- 7Departments of Nursing, The First Hospital of Shanxi Medical University, Taiyuan, China
- Wanhua Yang
- 8Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Xu Yao
- 9Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Chunshui Yu
- 0Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- Siyan Zhan
- 1Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Guoqiang Zhang
- 2Department of Emergency, China-Japan Friendship Hospital, Beijing, China
- Minggui Wang
- 6Institute of Antibiotics, Huashan Hospital Fudan University, Shanghai, China
- Zhu Zhu
- 3Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Baoguo Zhou
- 4Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Jianqing Gu
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Mo Xian
- State Key Laboratory for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Yuan Lyu
- Department of Emergency Medicine and Chest Pain Center, Qilu Hospital of Shandong University, Institute of Emergency and Critical Care Medicine of Shandong University, Ji’nan, China
- Zhengqian Li
- 5Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Hangci Zheng
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Hangci Zheng
- School of Pharmaceutical Science, Peking University, Beijing, China
- Chang Cui
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Chang Cui
- School of Pharmaceutical Science, Peking University, Beijing, China
- Shuhua Deng
- 1Departments of Nursing, Peking University Third Hospital, Beijing, China
- Chao Huang
- 6National Center for Medical Service Administration, National Health Commission of the People’s Republic of China, Beijing, China
- Lisha Li
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Pengfei Liu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Peng Men
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Peng Men
- School of Pharmaceutical Science, Peking University, Beijing, China
- Chunli Shao
- 2Department of Internal Medicine, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Sai Wang
- Pharmacy Department, Xuanwu Hospital of Capital Medical University, Beijing, China
- Xiang Ma
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Xiang Ma
- 7Department of Physiology, Oklahoma University Health Science Center, Oklahoma City, OK, United States
- Qiang Wang
- 6National Center for Medical Service Administration, National Health Commission of the People’s Republic of China, Beijing, China
- Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Suodi Zhai
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- DOI
- https://doi.org/10.3389/fphar.2022.845689
- Journal volume & issue
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Vol. 13
Abstract
Background: For anaphylaxis, a life-threatening allergic reaction, the incidence rate was presented to have increased from the beginning of the 21st century. Underdiagnosis and undertreatment of anaphylaxis are public health concerns.Objective: This guideline aimed to provide high-quality and evidence-based recommendations for the emergency management of anaphylaxis.Method: The panel of health professionals from fifteen medical areas selected twenty-five clinical questions and formulated the recommendations with the supervision of four methodologists. We collected evidence by conducting systematic literature retrieval and using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.Results: This guideline made twenty-five recommendations that covered the diagnosis, preparation, emergency treatment, and post-emergency management of anaphylaxis. We recommended the use of a set of adapted diagnostic criteria from the American National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network (NIAID/FAAN), and developed a severity grading system that classified anaphylaxis into four grades. We recommended epinephrine as the first-line treatment, with specific doses and routes of administration for different severity of anaphylaxis or different conditions. Proper dosage is critical in the administration of epinephrine, and the monitor is important in the IV administration. Though there was only very low or low-quality evidence supported the use of glucocorticoids and H1 antagonists, we still weakly recommended them as second-line medications. We could not make a well-directed recommendation regarding premedication for preventing anaphylaxis since it is difficult to weigh the concerns and potential effects.Conclusion: For the emergency management of anaphylaxis we conclude that:• NIAID/FAAN diagnostic criteria and the four-tier grading system should be used for the diagnosis• Prompt and proper administration of epinephrine is critical.
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