Comparison with previous research
This review differs from previous reviews because it excluded
non-consecutive case series, registry and cohort studies and other
observational methods at high risk of bias. The rationale was to focus
on research designs of higher quality to best inform the EAACI
guideline. This means that there are some differences in our findings
compared to past reviews. In particular, we found little evidence about
the effectiveness of adrenaline or any other acute management
approaches, whereas reviews that have included observational study
designs have found trends towards improved health outcomes and fewer
hospital admissions when adrenaline is used as first-line
treatment.11Shaker MS, Wallace DV, Golden DBK, Oppenheimer J,
Bernstein JA, Campbell RL, Dinakar C, Ellis A, Greenhawt M, Khan DA,
Lang DM, Lang ES, Lieberman JA, Portnoy J, Rank MA, Stukus DR, Wang J.
Anaphylaxis - a 2020 practice parameter update, systematic review, and
Grading of Recommendations, Assessment, Development and Evaluation
(GRADE) analysis. J Allergy Clin Immunol 2020;145(4):1082-1123.,22Simons
FER, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, et al.
2015 update of the evidence base: World Allergy Organization
anaphylaxis guidelines. World Allergy Organ J 2015;8:32.,33Chipps
BE. Update in pediatric anaphylaxis: a systematic review. Clin Pediatr
2013;52(5):451-461.
Our review differs from the 2020 American Practice Parameter44Shaker
MS, Wallace DV, Golden DBK, Oppenheimer J, Bernstein JA, Campbell RL,
Dinakar C, Ellis A, Greenhawt M, Khan DA, Lang DM, Lang ES, Lieberman
JA, Portnoy J, Rank MA, Stukus DR, Wang J. Anaphylaxis - a 2020
practice parameter update, systematic review, and Grading of
Recommendations, Assessment, Development and Evaluation (GRADE)
analysis. J Allergy Clin Immunol 2020;145(4):1082-1123. which focused
primarily on prophylactic use of glucocorticoids and antihistamine
premedication. Our narrower study design inclusion criteria were
designed to collate the most robust research. This meant that we found
few eligible studies about premedication compared to the Practice
Parameter. Furthermore immunotherapy studies were not eligible for our
review. Another difference is that we included only studies of clear and
explicit anaphylaxis and excluded studies which explored ‘reactions’
whereas the American Practice Parameter included a broader range of
reactions. On the other hand, the wider scope of our review means we
have explored educational initiatives and non-pharmacological long-term
management approaches, which were not covered in the Practice Parameter.
Thus, our review complements that undertaken for the Practice Parameter
as each had a different focus.