International consensus on (ICON) anaphylaxis

TLDR

Anaphylaxis guidelines issued between 2010 and 2014 by four allergy/immunology societies agree on clinical features and the need for immediate intramuscular epinephrine, positioning, and supportive care. The ICON initiative seeks to foster global collaboration and a comprehensive research agenda to better understand epidemiology, risk factors, triggers, diagnosis, and prevention of anaphylaxis. ICON is disseminated as an international information resource, providing summary tables, 130 key references, and guidance for healthcare professionals, academics, policy‑makers, patients, caregivers, and the public. The guidelines concur that epinephrine is the first‑line treatment, that antihistamines and steroids are not initial choices, and recommend epinephrine auto‑injectors, personalized action plans, and specialist follow‑up, while highlighting unmet needs for oxygen, fluids, and auto‑injectors worldwide.

Abstract

ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction.They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice.For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences.ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available.ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research.In addition to confirming the alignment of major anaphylaxis guidelines, ICON: Anaphylaxis adds value by including summary tables and citing 130 key references. It is published as an information resource about anaphylaxis for worldwide use by healthcare professionals, academics, policy-makers, patients, caregivers, and the public.