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      International consensus on (ICON) anaphylaxis

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          Abstract

          ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction.

          They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H 1-antihistamines, H 2-antihistamines, and glucocorticoids are not initial medications of choice.

          For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences.

          ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available.

          ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research.

          In addition to confirming the alignment of major anaphylaxis guidelines, ICON: Anaphylaxis adds value by including summary tables and citing 130 key references. It is published as an information resource about anaphylaxis for worldwide use by healthcare professionals, academics, policy-makers, patients, caregivers, and the public.

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          Most cited references 107

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          AGREE II: advancing guideline development, reporting and evaluation in health care.

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            Allergen immunotherapy: a practice parameter third update.

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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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                Author and article information

                Contributors
                Journal
                World Allergy Organ J
                World Allergy Organ J
                The World Allergy Organization Journal
                World Allergy Organization
                1939-4551
                2014
                30 May 2014
                : 7
                : 1
                : 9
                Affiliations
                [1 ]Department of Pediatrics & Child Health and Department of Immunology, Faculty of Medicine, University of Manitoba, Room FE125, 820 Sherbrook Street, Winnipeg, Manitoba, Canada, R3A 1R9
                [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, Ancona, Italy
                [4 ]Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
                [5 ]Department of Allergy, National Hospital Organization, Sagamihara National Hospital, Clinical Research Center for Allergy & Rheumatology, Kanagawa, Japan
                [6 ]Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
                [7 ]Allergy and Asthma Associates, Germantown, TN, USA
                [8 ]University of South Florida Morsani College of Medicine, Tampa, FL, USA
                [9 ]Department of Women and Child Health, Food Allergy Referral Centre, University of Padua, Padua, Italy
                [10 ]University of Southampton Faculty of Medicine, Southampton, United Kingdom, David Hide Asthma and Allergy Research Centre, St. Mary’s Hospital, Isle of Wight, United Kingdom
                [11 ]Centro Medico Docente La Trinidad, Caracas, Clinica El Avila, Caracas, Venezuela
                [12 ]Center for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom and Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
                [13 ]Department of Pediatrics, National University of Singapore, Singapore
                [14 ]Nova Southeastern University, Fort Lauderdale, FL, USA
                [15 ]Allergie-Centrum-Charité, Klinik fur Dermatologie und Allergologie, Charité, Universitatsmedizin, Berlin, Germany
                Article
                1939-4551-7-9
                10.1186/1939-4551-7-9
                4038846
                Copyright © 2014 Simons et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Consensus Document

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