Persistent, refractory, and biphasic anaphylaxis: A multidisciplinary Delphi study - 04/11/20
, Hugh A. Sampson, MD c, Carlos A. Camargo, MD, DrPH d, David C. Brousseau, MD, MS e, Jonathan M. Spergel, MD, PhD f, Mark I. Neuman, MD, MPH g, h, Marcus Shaker, MD, MSc i, j, Ronna L. Campbell, MD, PhD k, Kenneth A. Michelson, MD, MPH g, h, Susan A. Rudders, MD, MS l, m, Amal H. Assa’ad, MD b, n, Kimberly A. Risma, MD, PhD b, n, Mariana Castells, MD, PhD o, Lynda C. Schneider, MD l, m, Julie Wang, MD c, Juhee Lee, MD f, Rakesh D. Mistry, MD, MS p, David Vyles, DO, MS e, Lisa M. Vaughn, PhD q, Daniel J. Schumacher, MD, PhD a, b, John K. Witry, MS r, Shiv Viswanathan, PhD, PMP r, Erica M. Page, MS s, David Schnadower, MD, MPH a, bAbstract |
Background |
The use of inconsistent definitions for anaphylaxis outcomes limits our understanding of the natural history and epidemiology of anaphylaxis, hindering clinical practice and research efforts.
Objective |
Our aim was to develop consensus definitions for clinically relevant anaphylaxis outcomes by utilizing a multidisciplinary group of clinical and research experts in anaphylaxis.
Methods |
Using Delphi methodology, we developed agenda topics and drafted questions to review during monthly conference calls. Through online surveys, a 19-member panel consisting of experts in allergy and/or immunology and emergency medicine rated their level of agreement with the appropriateness of statements on a scale of 1 to 9. A median value of 1.0 to 3.4 was considered inappropriate, a median value of 3.5 to 6.9 was considered uncertain, and a median value of 7.0 to 9.0 was considered appropriate. A disagreement index was then calculated, with values less than 1.0 categorized as “consensus reached.” If consensus was not reached after the initial survey, subsequent surveys incorporating the aggregate de-identified responses from prior surveys were sent to panel members. This process was repeated until consensus was reached or 4 survey rounds had been completed, after which the question was categorized as “no consensus reached.”
Results |
The panel developed outcome definitions for persistent, refractory, and biphasic anaphylaxis, as well as for persistent and biphasic nonanaphylactic reactions. There was also consensus among panel members regarding the need to develop an anaphylaxis severity grading system.
Conclusion |
Dissemination and application of these definitions in clinical care and research will help standardize the terminology used to describe anaphylaxis outcomes and serve as the foundation for future research, including research aimed at development of an anaphylaxis severity grading system.
Le texte complet de cet article est disponible en PDF.Key words : Anaphylaxis, biphasic anaphylaxis, biphasic nonanaphylactic reactions, Delphi, emergency department, persistent anaphylaxis, persistent nonanaphylactic reactions, refractory anaphylaxis
Abbreviations used : DI, ED, NIAID/FAAN
Plan
| Supported by the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center. |
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| Disclosure of potential conflict of interest: H. A. Sampson receives funding to his institution for grants from the National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases (NIAID) and is employed part-time by and has received stock options from DBV Technologies. C. A. Camargo has consulted for Bryn Pharma and Kaleo. D. C. Brousseau receives funding from the NIH and Maternal and Child Health Bureau. J. M. Spergel has grant support from DBV Technology, AImmune, and NIH; he has consulted for Kaleo. M. Shaker has a brother who is chief executive officer of Altrix Medical. He is a member of the Joint Task Force on Practice Parameters and serves as an editorial board member for the Journal of Allergy and Clinical Immunology In Practice, Annals of Allergy, Asthma, and Immunology, and Journal of Food Allergy. R. L. Campbell has been a peer reviewer for EB Medicine and an author for UpToDate. K. A. Michelson receives funding from Agency for Healthcare Research and Quality. A. H. Assa’ad has research grants from NIH, Aimmune, DBV Technologies, Astellas, AbbVie, and Sanofi. M. Castells is the Brigham and Women's Hospital principal investigator for the PIONEER BluPrint Clinical trial for Indolent Systemic Mastocytosis. L. C. Schneider has received research support from Regeneron Pharmaceuticals, DBV Technologies, Pfizer, and Genentech; in addition, he has consulted for Aimmune Therapeutics and is on the Medical Advisory Board of FARE (Food Allergy Research and Education). J. Wang receives research support from NIAID, Aimmune, DBV Technologies, and Regeneron, as well as consultancy fees from Aimmune, ALK-Abelló, DBV Technologies, and Genentech. R. Mistry receives funding from the NIAID. D. Schnadower receives funding from the NIH. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 146 - N° 5
P. 1089-1096 - novembre 2020 Retour au numéro
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