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Anaphylaxis management plans for the acute and long-term management of anaphylaxis: A systematic reviewUlugbek Nurmatov, MD, PhD, Allison Worth, BSc (Hons), PhD, and Aziz Sheikh, MD, FRCP Anaphylaxis is an acute, life-threatening medical emergency with many potential triggers. Health Care Providers are frequently requested to fill out Anaphylaxis Management Plans. August typically provides a flood of such requests as students take their seats in the classroom for the new school year. Anaphylaxis management plans (AMPs) are increasingly called for to improve outcomes and reduce the risk of recurrence in persons with anaphylaxis. The authors of this study, published in the August 2008 issue of the Journal of Allergy and Clinical Immunology, observe that there are currently no universally accepted AMPs and the evidence to support use of self-management plans is extremely weak. Although a number of AMPs exist, other than agreement on the central importance of early administration of self-administered epinephrine, there is a range of perspectives on what should be included. Despite some concerns, the authors believe that formal randomized controlled trials comparing AMPs with standard models of care for patients likely to experience anaphylaxis might be ethical and necessary before any general recommendation about their clinical value can be made. Practice parameters have been developed by the Joint Task Force on Practice Parameters (representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology) to improve the care of patients by providing physicians with an evidence-based approach to the diagnosis and management of anaphylactic reactions. What the authors claim is missing is a concise management plan acceptable to patients/caregivers and professionals for use in everyday life. The authors point out that effectiveness of AMPs need to be formally evaluated The key components of AMPs need to be agreed upon, both in relation to acute and long-term management considerations and the subsequent evaluation of AMPs using practical approaches. In the recent past, the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing practice parameters for the diagnosis and management of anaphylaxis. The stated goal of this current study is to help catalyze further research, and inform policy making in relation to the management of anaphylaxis. Perhaps this study will challenge these leaders to join the effort towards broadly usable AMPs. |
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