Comparison of Anaphylaxis Diagnostic Criteria and Management Guidelines for the Prehospital Setting

Abstract

Introduction Anaphylaxis is a potentially life-threatening medical emergency and a challenge for emergency healthcare providers. There appears to be a lack of consistency in the international definition and management of anaphylaxis. The objective of this study was to review current international guidelines in diagnostic and management of anaphylaxis in the pre-hospital setting. Methods A literature search was conducted of the medical related electronic databases, Ovid MEDLINE, Cinahl, Cochrane CENTRAL and EMBASE from 1980 to the end of May 2013. A previously published pre-hospital search filter was used in each of the databases including additional keywords, ‘anaphylaxis’, ‘diagnosis’, ‘hypersensitivity’, ‘allergy’, ‘allergic reaction’, ‘adrenaline’, ‘epinephrine’ and ‘antihistamine’. Articles were included if their primary aim was to report of the evidence used to create international guidelines of anaphylaxis diagnosis and management. The references of retrieved articles were also reviewed. Articles were excluded if they were not written in English. Results There were 128 articles located by the search with 18 meeting the inclusion criteria. Of these, three were literature reviews and six reported on the introduction of anaphylaxis guidelines, including medical treatment in different countries. Three retrospective studies evaluated the efficiency of current diagnostic and management in hospital setting. Two questionnaire surveys were conducted internationally. There were two articles proposing diagnostic criteria and a rating method for anaphylaxis. Two were relevant to pre -hospital studies. Conclusion The inconsistency of definition and diagnosis criteria increases the risk of under-diagnosis and under-treatment of patients with anaphylaxis. Emergency healthcare providers need a more explicit set of diagnosis criteria and guidelines for treatment to rapidly relieve patients’ anaphylactic reaction and potentially life-threatening situation.