Implications for research
This review highlights the need for further research. With regards to diagnosis, robust studies are needed to test the feasibility of various criteria against gold standard expert review and the value of other approaches such as tryptase measurements to help confirm the diagnosis.
In terms of acute management, there is a paucity of robust evidence about adrenaline, but a lack of evidence is not the same as a lack of effect. It is unlikely that randomised comparative studies of adrenaline versus no adrenaline would be undertaken as it would be considered unethical to withhold a potentially life-saving treatment. However much remains left to learn about adrenaline, such as the ideal dosage and delivery mechanism required for adults and children, including those weighing less than 15kgs. Robust studies comparing the most effective number of autoinjectors to prescribe would also inform practice.
Long-term management and prevention may help people to identify triggers, minimise the risk of further reactions, learn skills and address psychological consequences. Various educational programmes, smartphone apps and leaflets have been developed, and anaphylaxis management plans and legislation have been implemented in some areas. Randomised trials or quasi-randomised studies would help to understand whether such approaches are worth expanding.