A Clinical Practice Guideline for the Emergency Management of Anaphylaxis (2020)

被引：15

作者：

Li, Xiaotong ^{[1
,2
,3
]}

Ma, Qingbian ^{[4
]}

Yin, Jia ^{[5
]}

Zheng, Ya'an ^{[4
]}

Chen, Rongchang ^{[6
]}

Chen, Yuguo ^{[7
,8
]}

Li, Tianzuo ^{[9
]}

Wang, Yuqin ^{[10
]}

Yang, Kehu ^{[11
]}

Zhang, Hongjun ^{[12
]}

Tang, Yida ^{[13
]}

Chen, Yaolong ^{[11
]}

Dong, Hailong ^{[14
]}

Gu, Qinglong ^{[15
]}

Guo, Daihong ^{[16
]}

Hu, Xuehui ^{[17
]}

Xie, Lixin ^{[18
]}

Li, Baohua ^{[12
]}

Li, Yuzhen ^{[19
]}

Lin, Tongyu ^{[20
]}

Liu, Fang ^{[1
]}

Liu, Zhiqiang ^{[21
]}

Lyu, Lanting ^{[22
,23
]}

Mei, Quanxi ^{[24
]}

Shao, Jie ^{[25
]}

Xin, Huawen ^{[26
]}

Yang, Fan ^{[27
]}

Yang, Hui ^{[28
]}

Yang, Wanhua ^{[29
]}

Yao, Xu ^{[30
]}

Yu, Chunshui ^{[31
,32
]}

Zhan, Siyan ^{[33
]}

Zhang, Guoqiang ^{[34
]}

Wang, Minggui ^{[27
]}

Zhu, Zhu ^{[35
]}

Zhou, Baoguo ^{[36
]}

Gu, Jianqing ^{[5
]}

Xian, Mo ^{[6
]}

Lyu, Yuan ^{[7
,8
]}

Li, Zhengqian ^{[37
]}

Zheng, Hangci ^{[1
,2
]}

Cui, Chang ^{[1
,2
]}

Deng, Shuhua ^{[12
]}

Huang, Chao ^{[38
]}

Li, Lisha ^{[5
]}

Liu, Pengfei ^{[9
]}

Men, Peng ^{[1
,2
]}

Shao, Chunli ^{[13
]}

Wang, Sai ^{[10
]}

Ma, Xiang ^{[1
,39
]}

机构：

[1] Peking Univ Third Hosp, Dept Pharm, Beijing, Peoples R China

[2] Peking Univ, Sch Pharmaceut Sci, Beijing, Peoples R China

[3] Peking Univ, Hlth Sci Ctr, Inst Drug Evaluat, Beijing, Peoples R China

[4] Peking Univ Third Hosp, Emergency Dept, Beijing, Peoples R China

[5] Chinese Acad Med Sci & Peking Union Med Coll, Peking Union Med Coll Hosp, Dept Allergy, Beijing, Peoples R China

[6] Guangzhou Med Univ, Affiliated Hosp 1, Guangzhou Inst Resp Hlth, State Key Lab Resp Dis, Guangzhou, Peoples R China

[7] Shandong Univ, Qilu Hosp, Inst Emergency & Crit Care Med, Dept Emergency Med, Jinan, Peoples R China

[8] Shandong Univ, Qilu Hosp, Inst Emergency & Crit Care Med, Chest Pain Ctr, Jinan, Peoples R China

[9] Capital Med Univ, Beijing Shijitan Hosp, Dept Anesthesiol, Beijing, Peoples R China

[10] Capital Med Univ, Xuanwu Hosp, Pharm Dept, Beijing, Peoples R China

[11] Lanzhou Univ, Evidence Based Med Ctr, Sch Basic Med Sci, Lanzhou, Peoples R China

[12] Peking Univ Third Hosp, Dept Nursing, Beijing, Peoples R China

[13] Chinese Acad Med Sci & Peking Union Med Coll, Fuwai Hosp, Coronary Heart Dis Ctr, Dept Internal Med, Beijing, Peoples R China

[14] Fourth Mil Med Univ, Xijing Hosp, Dept Anesthesiol & Perioperat Med, Xian, Peoples R China

[15] Capital Inst Pediat, Childrens Hosp, Dept Otolaryngol, Beijing, Peoples R China

[16] Chinese PL Gen Hosp, Pharm Dept, Beijing, Peoples R China

[17] Fourth Mil Med Univ, Xijing Hosp, Dept Nursing, Xian, Peoples R China

[18] Chinese Peoples Liberat Army Gen Hosp, Dept Pulm & Crit Care Med, Beijing, Peoples R China

[19] Peking Univ Peoples Hosp, Dept Pharm, Beijing, Peoples R China

[20] Sun Yat Sen Univ, Collaborat Innovat Ctr Canc Med, Dept Med Oncol, Canc Ctr,State Key Lab Oncol South China, Guangzhou, Peoples R China

[21] Tongji Univ, Sch Med, Shanghai Matern & Infant Hosp 1, Dept Anesthesiol, Shanghai, Peoples R China

[22] Renmin Univ China, Sch Publ Adm & Policy, Beijing, Peoples R China

[23] Renmin Univ China, Hlth Technol Assessment & Hlth Policy Res Grp, Beijing, Peoples R China

[24] Shenzhen Baoan Pure Chinese Med Treatment Hosp, Dept Pharm, Shenzhen, Peoples R China

[25] Shanghai Jiao Tong Univ, Ruijin Hosp, Sch Med, Dept Pediat, Shanghai, Peoples R China

[26] Gen Hosp Cent Theater Command PLA, Dept Clin Pharmacol, Wuhan, Peoples R China

[27] Fudan Univ, Huashan Hosp, Inst Antibiot, Shanghai, Peoples R China

[28] Shanxi Med Univ, Hosp 1, Dept Nursing, Taiyuan, Peoples R China

[29] Shanghai Jiao Tong Univ, Ruijin Hosp, Sch Med, Dept Pharm, Shanghai, Peoples R China

[30] Chinese Acad Med Sci & Peking Union Med Coll, Inst Dermatol, Nanjing, Peoples R China

[31] Tianjin Med Univ, Gen Hosp, Dept Radiol, Tianjin, Peoples R China

[32] Tianjin Med Univ, Gen Hosp, Tianjin Key Lab Funct Imaging, Tianjin, Peoples R China

[33] Peking Univ, Sch Publ Hlth, Hlth Sci Ctr, Dept Epidemiol & Biostat, Beijing, Peoples R China

[34] China Japan Friendship Hosp, Dept Emergency, Beijing, Peoples R China

[35] Chinese Acad Med Sci, Peking Union Med Coll Hosp, Dept Pharm, Beijing, Peoples R China

[36] Harbin Med Univ, Affiliated Hosp 1, Dept Gen Surg, Harbin, Peoples R China

[37] Peking Univ Third Hosp, Dept Anesthesiol, Beijing, Peoples R China

[38] Natl Hlth Commiss Peoples Republ China, Natl Ctr Med Serv Adm, Beijing, Peoples R China

[39] Oklahoma Univ, Hlth Sci Ctr, Dept Physiol, Oklahoma City, OK USA

来源：

FRONTIERS IN PHARMACOLOGY | 2022年 / 13卷

关键词：

anaphylaxis; clinical practice guideline; epinephrine; emergency management; severity grading system; AMERICAN-HEART-ASSOCIATION; PRACTICE PARAMETER UPDATE; LONG-TERM MANAGEMENT; BIPHASIC REACTIONS; PERIOPERATIVE ANAPHYLAXIS; CARDIOPULMONARY-RESUSCITATION; EPINEPHRINE ABSORPTION; DEPARTMENT DIAGNOSIS; POSTMORTEM FINDINGS; NATIONAL INSTITUTE;

D O I：

10.3389/fphar.2022.845689

中图分类号：

R9 [药学];

学科分类号：

1007 ;

摘要：

Background: For anaphylaxis, a life-threatening allergic reaction, the incidence rate was presented to have increased from the beginning of the 21st century. Underdiagnosis and undertreatment of anaphylaxis are public health concerns.Objective: This guideline aimed to provide high-quality and evidence-based recommendations for the emergency management of anaphylaxis.Method: The panel of health professionals from fifteen medical areas selected twenty-five clinical questions and formulated the recommendations with the supervision of four methodologists. We collected evidence by conducting systematic literature retrieval and using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.Results: This guideline made twenty-five recommendations that covered the diagnosis, preparation, emergency treatment, and post-emergency management of anaphylaxis. We recommended the use of a set of adapted diagnostic criteria from the American National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network (NIAID/FAAN), and developed a severity grading system that classified anaphylaxis into four grades. We recommended epinephrine as the first-line treatment, with specific doses and routes of administration for different severity of anaphylaxis or different conditions. Proper dosage is critical in the administration of epinephrine, and the monitor is important in the IV administration. Though there was only very low or low-quality evidence supported the use of glucocorticoids and H1 antagonists, we still weakly recommended them as second-line medications. We could not make a well-directed recommendation regarding premedication for preventing anaphylaxis since it is difficult to weigh the concerns and potential effects.Conclusion: For the emergency management of anaphylaxis we conclude that:center dot NIAID/FAAN diagnostic criteria and the four-tier grading system should be used for the diagnosis center dot Prompt and proper administration of epinephrine is critical.

引用

页数：22

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