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.