Anaphylaxis
Also known as: epinephrine · severe allergic reaction
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Anaphylaxis: A 2023 practice parameter update
AAAAI/ACAAI Joint Task Force on Practice Parameters · 2024 · 2023 update
The current US Joint Task Force practice parameter on anaphylaxis, released online in December 2023 and published in the February 2024 issue of Annals of Allergy, Asthma & Immunology. It concentrates on seven areas where new evidence prompted new recommendations, including revised diagnostic criteria, recognised patterns of anaphylaxis, the role of serum tryptase, and features specific to infants and toddlers. Linked via PubMed because the journal site blocks automated access; AAAAI also hosts the full PDF.
EAACI guidelines: Anaphylaxis (2021 update)
European Academy of Allergy and Clinical Immunology (EAACI) · 2022 · 2021 update
EAACI's current guideline on diagnosis, acute management and prevention of anaphylaxis, produced by a multidisciplinary task force using the AGREE II framework and GRADE methodology. It updates the 2014 EAACI anaphylaxis guideline and covers recognition, emergency treatment, long-term risk reduction, adrenaline autoinjector provision and training of patients and healthcare staff. Linked via PubMed because the publisher's site blocks automated access.
US vs EU key differences
- Autoinjector prescribing is risk-tiered in the US parameter: clinicians should routinely prescribe devices to higher-risk patients but use shared decision-making for lower-risk patients, and should prescribe at least two devices to anyone with a history of anaphylaxis needing multiple epinephrine doses or a biphasic reaction. source
- Available device strengths differ by jurisdiction: the FDA has approved 0.1, 0.15 and 0.3 mg autoinjectors, while regulators in some other countries also approve a 0.5 mg device for patients over 60 kg; US expert consensus nonetheless supports switching to 0.3 mg at 25 kg and 0.5 mg at 45 kg where available, to limit underdosing. source
- Core management converges: both name prompt intramuscular epinephrine/adrenaline as first-line, both stress structured patient training and community availability of autoinjectors, and both note the evidence base remains largely very low certainty. source
- The US parameter adds specific mast-cell workup guidance, advising baseline serum tryptase measurement and consideration of bone marrow biopsy for adults with severe insect-sting anaphylaxis or recurrent idiopathic anaphylaxis. source
What changed recently
- US2015 → 2023 update2023-12-18
Superseding the 2015 practice parameter, the 2023 update revises the diagnostic criteria for anaphylaxis and defines distinct patterns of the reaction, elevates serum tryptase measurement as a route to diagnosis and to detecting underlying mast cell disorders, and flags age-specific presentations in infants and toddlers. It also softens the old caution on beta-blockers and ACE inhibitors, judging that for most indications stopping them carries more risk than continuing, and recommends considering bone marrow biopsy after severe insect-sting or recurrent idiopathic anaphylaxis in adults.
source ↗curation confidence 90% - EU2014 → 2021 update2022-02-01
The task force reworked the 2014 EAACI anaphylaxis guideline using AGREE II and GRADE, and set out weight-banded adrenaline autoinjector prescribing: 0.15 mg for children from roughly 7.5 kg up to 25-30 kg and at least 0.3 mg above that, including for adolescents and adults at risk. It also asks manufacturers to publish device pharmacokinetic data and adds recommendations on structured patient training, simulation training for clinicians and aligning school policies with anaphylaxis guidance.
source ↗curation confidence 80%
See the full update feed for changes across every system.