CHILDHOOD ANAPHYLAXIS: NEW DEVELOPMENTS IN DIAGNOSIS AND TREATMENT

CHILDHOOD_ANAPHYLAXIS_NEW_DEVELOPMENTS _IN_DIAGNOSIS_AND_TREATMENT_kapak

ANAPHYLAXIS DIAGNOSIS ACROSS GUIDELINES

Sinem Polat Terece

Balıkesir Atatürk City Hospital, Department of Pediatric Immunology and Allergic Diseases, Balıkesir, Türkiye

Polat Terece S. Anaphylaxis Diagnosis Across Guidelines. In: Harmancı K, editor. Childhood Anaphylaxis: New Developments in Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.215-222.

ABSTRACT

Anaphylaxis represents the most severe form of acute allergic reactions and can be fatal. It is well recognized that the incidence of anaphylaxis related to all types of triggers has been increasing globally. Given that this condition can be encountered by physicians and other healthcare professionals across all levels and specialties, its prompt recognition and appropriate management are of critical importance. The diagnosis, which is made clinically, can be challenging due to the wide spectrum of signs and symptoms anaphylaxis may present with. In this context, universally accepted and practical diagnostic criteria not only enhance patient management but also provide consistency for future clinical research in this field. The diagnostic criteria proposed by the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN), which have been widely adopted since 2006, were revised in 2020 by the World Allergy Organization (WAO). Although there are similarities between the two sets of criteria, notable differences exist in various clinical scenarios. The studies underscored that the inclusion of isolated respiratory symptoms in the WAO criteria might facilitate earlier intervention. Nevertheless, the authors cautioned that such presentations necessitate careful evaluation to avoid misinterpreting these symptoms as other respiratory disorders, such as asthma or vocal cord dysfunction, or as manifestations of panic attacks or anxiety disorders. On the other hand, some drug-induced anaphylaxis cases that met the NIAID/FAAN criteria having no skin symptoms nor objective findings such as hypotension, laryngospasm, or bronchospasm were not diagnosed as anaphylaxis according to the WAO criteria. Prospective validation of the new WAO criteria, along with extensive, large-scale, multicenter clinical studies, are required to reassess both sets of criteria and to develop standardized, practical, and universally applicable diagnostic criteria that can be easily implemented across all levels of care.

Keywords: Anaphylaxis; Diagnosis; Practice guideline; Validation study

Referanslar

  1. Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13(10):100472. [Crossref]  [PubMed]  [PMC]
  2. Wang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL and Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: A systematic review. Allergy. 2019;74(6):1063-1080. [Crossref]  [PubMed]
  3. Turner PJ, Campbell DE, Motosue MS, Campbell RL. Global Trends in Anaphylaxis Epidemiology and Clinical Implications. J Allergy Clin Immunol Pract. 2020;8(4):1169-1176. [Crossref]  [PubMed]  [PMC]
  4. Tejedor-Alonso M A, Moro-Moro M, Múgica-García MV. Epidemiology of Anaphylaxis: Contributions From the Last 10 Years. J Investig Allergol Clin Immunol. 2015;25(3):163-175.
  5. Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal Anaphylaxis: Mortality Rate and Risk Factors. J Allergy Clin Immunol Pract. 2017;5(5):1169-1178. [Crossref]  [PubMed]  [PMC]
  6. Golden DBK, Wang J, Waserman S, Akin C, Campbell RL, Ellis AK,et al. Anaphylaxis: A 2023 practice parameter update. Ann Allergy Asthma Immunol. 2024;132(2):124-176. [Crossref]  [PubMed]
  7. Sampson HA, Muñoz-Furlong A, Bock SA, Schmitt C, Bass R, Chowdhury BA, et al. Symposium on the definition and management of anaphylaxis: summary report. J Allergy Clin Immunol. 2005;115(3):584-591. [Crossref]  [PubMed]
  8. Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF, Bock SA, Branum, A. et al. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391-397. [Crossref]  [PubMed]
  9. Simons FE, Ardusso LR, Bilò MB, El-Gamal YM, Ledford DK, Ring J, et al. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13-37. [Crossref]  [PubMed]  [PMC]
  10. Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunolo gy. Allergy. 2014;69(8):1026-1045. [Crossref]  [PubMed]
  11. Loprinzi Brauer CE, Motosue MS, Li JT, Bellolio MF, Lee S, Campbell RL, et al. Prospective Validation of the NIAID/ FAAN Criteria for Emergency Department Diagnosis of Anaphylaxis. J Allergy Clin Immunol Pract. 2016;4(6):12201226. [Crossref]  [PubMed]
  12. Muraro A, Worm M, Alviani C, Cardona V, DunnGalvi A, Garvey LH, et al. EAACI guidelines: Anaphylaxis (2021 update). Allergy. 2022;77(2):357-377. [Crossref]  [PubMed]
  13. Turner PJ, Worm M, Ansotegui IJ, El-Gamal Y, Rivas MF, Fineman S, et al. Time to revisit the definition and clinical criteria for anaphylaxis?. World Allergy Organ J. 2019;12(10):100066. [Crossref]  [PubMed]  [PMC]
  14. Aytekin Güvenir F, Yörüsün G, Dere R, Selmanoğlu A, Şengül Emeksiz Z, Dibek Mısırlıoğlu E. Retrospective evaluation of pediatric anaphylaxis cases according to WAO and NIAID/FAAN/EAACI criteria: A single center experience. World Allergy Organ J. 2024;17(11):100982. [Crossref]  [PubMed]  [PMC]
  15. Yeğit OO, Aslan AF, Coşkun R, Karadağ P, Toprak İD, Can A, et al. Comparison of recent anaphylaxis diagnostic criteria in real life: Can more patients be diagnosed as having anaphylaxis?. World Allergy Organ J. 2023;16(8):100810. [Crossref]  [PubMed]  [PMC]
  16. Çolak S, Erkoç M, Sin BA, Bavbek S. Comparison of two diagnostic criteria in the diagnosis of anaphylaxis in a tertiary adult allergy clinic. World Allergy Organ J. 2023;16(3):100761. [Crossref]  [PubMed]  [PMC]
  17. Ade J, Jeffery M, Hagan J, Li J, Alpern M, Liu XW, et al. Validation of the revised national Institute of allergy and infectious disease/food allergy and anaphylaxis Network diagnostic criteria in emergency department patients. J Allergy Clin Immunol. 2021;147: AB240. [Crossref]
  18. Nowak R, Farrar JR, Brenner BE, Lewis L, Silverman RA, Emerman C, et al. Customizing anaphylaxis guidelines for emergency medicine. J Emerg Med. 2013;45(2):299-306. [Crossref]  [PubMed]
  19. Golden DBK, Wang J, Waserman S, Akin C, Campbell RL, Ellis AK, et al. Anaphylaxis: A 2023 practice parameter update. Ann Allergy Asthma Immunol. 2024;132(2):124-176. [Crossref]  [PubMed]
  20. Wallace DV. Knowledge gaps in the diagnosis and management of anaphylaxis. Ann Allergy Asthma Immunol. 2023;131(2):151-169. [Crossref]  [PubMed]
  21. Greenhawt M, Gupta RS, Meadows JA, Pistiner M, Spergel JM, Camargo CA, et al. Guiding Principles for the Recognition, Diagnosis, and Management of Infants with Anaphylaxis: An Expert Panel Consensus. J Allergy Clin Immunol Pract. 2019;7(4):1148-1156. [Crossref]  [PubMed]