Summary of evidence
We found little robust evidence about the most effective strategies to diagnose, manage or prevent anaphylaxis. There were only three areas where the certainty of evidence was not ‘very low’. Firstly, newer / modified models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce the time taken to administer adrenaline. Secondly, face-to-face training probably improves knowledge about anaphylaxis in people at risk of anaphylaxis and their family and may slightly improve laypeople’s competence in administering adrenaline autoinjectors. Face-to-face training can be of varying duration and content, but there is little evidence about the most effective type of training. Thirdly, adrenaline prophylaxis prior to snake bite anti-venom may reduce anaphylaxis. However, this evidence comes largely from Asia and may relate to types of anti-venoms that are not commonly used in other parts of the world.
For all other diagnostic and management interventions, the evidence was of too low certainty to draw conclusions. We searched for but found no eligible studies examining treatments that have been considered as adjuncts to adrenaline such as fluid replacement, oxygen, glucocorticosteroids (apart from for antivenom), methylxanthines and bronchodilators.