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.