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      World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

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          The illustrated World Allergy Organization (WAO) Anaphylaxis Guidelines were created in response to absence of global guidelines for anaphylaxis. Uniquely, before they were developed, lack of worldwide availability of essentials for the diagnosis and treatment of anaphylaxis was documented. They incorporate contributions from more than 100 allergy/immunology specialists on 6 continents. Recommendations are based on the best evidence available, supported by references published to the end of December 2010. The Guidelines review patient risk factors for severe or fatal anaphylaxis, co-factors that amplify anaphylaxis, and anaphylaxis in vulnerable patients, including pregnant women, infants, the elderly, and those with cardiovascular disease. They focus on the supreme importance of making a prompt clinical diagnosis and on the basic initial treatment that is urgently needed and should be possible even in a low resource environment. This involves having a written emergency protocol and rehearsing it regularly; then, as soon as anaphylaxis is diagnosed, promptly and simultaneously calling for help, injecting epinephrine (adrenaline) intramuscularly, and placing the patient on the back or in a position of comfort with the lower extremities elevated. When indicated, additional critically important steps include administering supplemental oxygen and maintaining the airway, establishing intravenous access and giving fluid resuscitation, and initiating cardiopulmonary resuscitation with continuous chest compressions. Vital signs and cardiorespiratory status should be monitored frequently and regularly (preferably, continuously). The Guidelines briefly review management of anaphylaxis refractory to basic initial treatment. They also emphasize preparation of the patient for self-treatment of anaphylaxis recurrences in the community, confirmation of anaphylaxis triggers, and prevention of recurrences through trigger avoidance and immunomodulation. Novel strategies for dissemination and implementation are summarized. A global agenda for anaphylaxis research is proposed.

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          Most cited references 126

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          Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

          The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.
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            The diagnosis and management of anaphylaxis practice parameter: 2010 update.

            These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "The Diagnosis and Management of Anaphylaxis Practice Parameter: 2010 Update." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, or the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. Copyright (c) 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
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              Clinical practice. Hereditary angioedema.

               Bruce Zuraw (2008)

                Author and article information

                World Allergy Organ J
                World Allergy Organ J
                The World Allergy Organization Journal
                World Allergy Organization Journal
                23 February 2011
                February 2011
                : 4
                : 2
                : 13-37
                [1 ]Department of Pediatrics & Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
                [2 ]Cátedra Neumonología, Alergia e Inmunología Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
                [3 ]Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
                [4 ]Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
                [5 ]University of South Florida College of Medicine, Tampa, FL
                [6 ]Department of Dermatology and Allergy, Technology Universitat Muenchen, Munich, Germany
                [7 ]Centro Medico Docente La Trinidad, Caracas, Clinica El Avila, Caracas, Venezuela
                [8 ]The Allergy Unit, Verona General Hospital, Verona, Italy
                [9 ]Center for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
                [10 ]Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore.
                Author notes

                This paper was approved by the WAO House of Delegates February 18, 2011.

                This paper is also being published in the Journal of Allergy and Clinical Immunology (JACI) as an electronic publication available online in March 2011. A summary of the article will appear in JACI in the March 2011 issue as: Simons FER, Ardusso LRF, Bilo MB, El-Gamal YM, Ledford DK, Ring J, et al. World Allergy Organization Anaphylaxis Guidelines: Summary. J Allergy Clin Immunol. 2011;127(3):587–93. e1-e20.

                DISCLAIMER: The information contained in the text, figures, and tables of the WAO Anaphylaxis Guidelines is correct at the time of publication; however, recommendations, for example, those for medications and doses, might need to be individualized according to the needs of the patient, and the medications, supplies, equipment, and skilled support available; moreover, recommendations change over time.

                Correspondence to: Prof. F. Estelle R. Simons, Room FE125 820 Sherbrook Street, Winnipeg, Manitoba, Canada, R3A 1R9. Telephone: 204-787-2537. Fax: 204-787-5040. E-mail: lmcniven@ 123456hsc.mb.ca .
                Copyright © 2011 by World Allergy Organization
                WAO Position Paper


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