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Management Strategies Of Idiopathic Anaphylaxis In The Emergency Room: Current Perspectives

Authors Le M, Gabrielli S, De Schryver S, Ben-Shoshan M

Received 21 July 2019

Accepted for publication 4 October 2019

Published 1 November 2019 Volume 2019:11 Pages 249—263


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Hans-Christoph Pape

Michelle Le, Sofianne Gabrielli, Sarah De Schryver, Moshe Ben-Shoshan

Division of Allergy, Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada

Correspondence: Michelle Le
Division of Pediatric Allergy, Clinical Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, 1001 Boul. Decarie, Montreal, Quebec H4A 3J1, Canada
Tel +1 514-412-4400 (23151)
Fax +1 514-412-4390

Background: Idiopathic anaphylaxis (IA) is a diagnosis of exclusion and represents a major diagnostic and management challenge. There are no current guidelines for diagnosis and management of IA. We aim to present a systematic review of the literature on adult and pediatric IA.
Methods: We conducted a systematic review of original articles published in the past 22 years regarding diagnosis and management strategies of adult and pediatric IA.
Results: The current proposed diagnostic approach and treatment regimens are based on a few small studies. Future large-scale studies are required. IA is a diagnosis of exclusion and should be made only after extensive evaluation excludes potential anaphylaxis triggers as well as non-allergic conditions with a similar presentation. There is currently no diagnostic consensus for IA. Furthermore, the current proposed treatment regimens are limited and rely on prophylactic treatment with antihistamines and prednisone for patients with frequent episodes. However, daily treatment with systemic steroids has well-recognized serious adverse effects. More recently, the use of biologics was suggested to benefit patients with IA, although the optimal management protocol is not yet established.
Conclusion: Future studies are needed to optimize diagnosis and treatment strategies in adult and pediatric cases of IA. Omalizumab may be a promising novel therapeutic option for adult and pediatric IA.

Keywords: anaphylaxis, diagnosis, management, treatment

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