| Pharmacologic treatment of anaphylaxis: can the evidence base be strengthened? | |
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MedLine Citation:
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PMID: 20585241 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE OF REVIEW: To evaluate the evidence base for the pharmacologic treatment of anaphylaxis. RECENT FINDINGS: In this review, we focus on four classes of medications (the alpha/beta-agonist epinephrine (adrenaline), H1-antihistamines, H2-antihistamines, and glucocorticoids) that are used in healthcare settings for the initial treatment of anaphylaxis. Epinephrine and many H1-antihistamines and glucocorticoids were introduced before the era of randomized controlled trials and before the era of evidence-based medicine. In anaphylaxis, no randomized controlled trials that are free from methodological problems and meet current standards have been performed with these medications, or with H2-antihistamines. The evidence base for epinephrine injection is stronger than the evidence base for use of other medications in anaphylaxis. Guidelines unanimously recommend prompt injection of epinephrine as the life-saving first-line medication in anaphylaxis; however, they differ in their recommendations for H1-antihistamines, H2-antihistamines, and glucocorticoids. Epinephrine is the only medication that is universally available for anaphylaxis treatment in healthcare settings worldwide. Paradoxically, it is underused in anaphylaxis treatment. SUMMARY: For ethical reasons, there should never be a placebo-controlled trial of epinephrine in anaphylaxis. We discuss why the possibility of conducting randomized placebo-controlled trials with H1-antihistamines, H2-antihistamines, and particularly with glucocorticoids in anaphylaxis should be considered in order to improve the evidence base for treatment and guide clinical decision-making. We also describe the precautions that will be needed if randomized controlled trials are conducted in anaphylaxis. |
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Authors:
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F Estelle R Simons |
Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Current opinion in allergy and clinical immunology Volume: 10 ISSN: 1473-6322 ISO Abbreviation: Curr Opin Allergy Clin Immunol Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-08 Completed Date: 2010-10-21 Revised Date: 2010-12-13 |
Medline Journal Info:
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Nlm Unique ID: 100936359 Medline TA: Curr Opin Allergy Clin Immunol Country: United States |
Other Details:
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Languages: eng Pagination: 384-93 Citation Subset: IM |
Affiliation:
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Department of Pediatrics & Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. lmcniven@hsc.mb.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anaphylaxis
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drug therapy* Anti-Allergic Agents / administration & dosage, therapeutic use* Epinephrine / administration & dosage, therapeutic use* Evidence-Based Medicine* Glucocorticoids / administration & dosage, therapeutic use* Histamine H1 Antagonists / administration & dosage, therapeutic use* Histamine H2 Antagonists / administration & dosage, therapeutic use* Humans Practice Guidelines as Topic Randomized Controlled Trials as Topic Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anti-Allergic Agents; 0/Glucocorticoids; 0/Histamine H1 Antagonists; 0/Histamine H2 Antagonists; 51-43-4/Epinephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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