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Management of Refractory Anaphylaxis: An Overview of Current Guidelines.
Pouessel, Guillaume; Dribin, Timothy E; Tacquard, Charles; Tanno, Luciana Kase; Cardona, Victoria; Worm, Margitta; Deschildre, Antoine; Muraro, Antonella; Garvey, Lene H; Turner, Paul J.
Afiliación
  • Pouessel G; Department of Paediatrics, Children's Hospital, Roubaix, France.
  • Dribin TE; Paediatric Pulmonology and Allergy Department, Jeanne de Flandre Hospital, CHU Lille, Lille, France.
  • Tacquard C; Univ Lille, ULR 2694: METRICS, Lille, France.
  • Tanno LK; Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  • Cardona V; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
  • Worm M; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
  • Deschildre A; Department of Anaesthesia and Intensive Care, Strasbourg University Hospital, Strasbourg, France.
  • Muraro A; University Hospital of Montpellier, Montpellier, France.
  • Garvey LH; Desbrest Institute of Epidemiology and Public Health, University of Montpellier - INSERM, Montpellier, France.
  • Turner PJ; WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.
Clin Exp Allergy ; 54(7): 470-488, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38866583
ABSTRACT
In this review, we compare different refractory anaphylaxis (RA) management guidelines focusing on cardiovascular involvement and best practice recommendations, discuss postulated pathogenic mechanisms underlining RA and highlight knowledge gaps and research priorities. There is a paucity of data supporting existing management guidelines. Therapeutic recommendations include the need for the timely administration of appropriate doses of aggressive fluid resuscitation and intravenous (IV) adrenaline in RA. The preferred second-line vasopressor (noradrenaline, vasopressin, metaraminol and dopamine) is unknown. Most guidelines recommend IV glucagon for patients on beta-blockers, despite a lack of evidence. The use of methylene blue or extracorporeal life support (ECLS) is also suggested as rescue therapy. Despite recent advances in understanding the pathogenesis of anaphylaxis, the factors that lead to a lack of response to the initial adrenaline and thus RA are unclear. Genetic factors, such as deficiency in platelet activating factor-acetyl hydrolase or hereditary alpha-tryptasaemia, mastocytosis may modulate reaction severity or response to treatment. Further research into the underlying pathophysiology of RA may help define potential new therapeutic approaches and reduce the morbidity and mortality of anaphylaxis.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Guías de Práctica Clínica como Asunto / Anafilaxia Límite: Humans Idioma: En Revista: Clin Exp Allergy Asunto de la revista: ALERGIA E IMUNOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Francia

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Guías de Práctica Clínica como Asunto / Anafilaxia Límite: Humans Idioma: En Revista: Clin Exp Allergy Asunto de la revista: ALERGIA E IMUNOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Francia