2012 Update

World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

F. Estelle R. Simons; Ledit R.F. Ardusso; M. Beatrice Biló; Vesselin Dimov; Motohiro Ebisawa; Yehia M. El-Gamal; Dennis K. Ledford; Richard F. Lockey; Johannes Ring; Mario Sanchez-Borges; Gian Enrico Senna; Aziz Sheikh; Bernard Y. Thong; Margitta Worm

Disclosures

Curr Opin Allergy Clin Immunol. 2012;12(4):389-399. 

In This Article

Abstract and Introduction

Abstract

Purpose of review The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis published in early 2011 provide a global perspective on patient risk factors, triggers, clinical diagnosis, treatment, and prevention of anaphylaxis. In this 2012 Update, subsequently published, clinically relevant research in these areas is reviewed.
Recent findings Patient risk factors and co-factors that amplify anaphylaxis have been documented in prospective studies. The global perspective on the triggers of anaphylaxis has expanded.
The clinical criteria for the diagnosis of anaphylaxis that are promulgated in the Guidelines have been validated. Some aspects of anaphylaxis treatment have been prospectively studied. Novel investigations of self-injectable epinephrine for treatment of anaphylaxis recurrences in the community have been performed. Progress has been made with regard to measurement of specific IgE to allergen components (component-resolved testing) that might help to distinguish clinical risk of future anaphylactic episodes to an allergen from asymptomatic sensitization to the allergen. New strategies for immune modulation to prevent food-induced anaphylaxis and new insights into subcutaneous immunotherapy to prevent venom-induced anaphylaxis have been described.
Summary Research highlighted in this Update strengthens the evidence-based recommendations for assessment, management, and prevention of anaphylaxis made in the WAO Anaphylaxis Guidelines.

Introduction

The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis (subsequently referred to as the Guidelines) were published on 3 March 2011[1] in response to the need for global guidelines on anaphylaxis diagnosis and treatment. Unique aspects of the Guidelines are summarized below.

The Guidelines were developed without corporate funding in response to absence of global guidelines for anaphylaxis, absence of national guidelines in most countries, and for use as an additional resource in countries with their own national guidelines. They were based on the best evidence available from publications in indexed, peer-reviewed journals to the end of 2010. They highlighted the role of the allergy/immunology specialist, particularly in prevention of anaphylactic episodes; however, they have been widely used by a broader group of healthcare professionals.[1]

The Guidelines were preceded by documentation of global availability of essentials for assessment and management of anaphylaxis. They provide a global perspective on anaphylaxis with regard to vulnerable patients, risk factors for severe or fatal anaphylaxis, and co-factors that amplify anaphylaxis symptoms, as well as perspective on mechanisms and triggers. They emphasize prompt clinical diagnosis, basic initial treatment, and prevention of anaphylaxis recurrences. They are written in a concise format (22 pages) with recommendations supported by citation of 150 references, most of which were published from 2006 to 2010. They include color illustrations that highlight the key concepts in the text. They propose a global agenda for anaphylaxis research ( Table 1 ).

Since co-publication (open access) in the Journal of Allergy & Clinical Immunology and the World Allergy Organization Journal in early 2011, the Guidelines have been disseminated worldwide in a variety of formats. They have been posted on the WAO website and on WAO member society websites. Summary posters and pocket cards have been translated into 10 languages, with additional translations pending. They have been presented in keynote and plenary sessions in congresses and meetings around the globe. They are used in undergraduate and postgraduate medical courses. They have become a resource for specialty areas beyond allergy/immunology, including sports medicine, for example, the 2012 Olympic Games Therapeutic Use Exemption Committee. They are also used in primary care and allied health.

In parallel, progress has been made on the global agenda proposed for anaphylaxis research ( Table 1 ), and more than 500 papers on human anaphylaxis have been published in indexed peer-reviewed medical journals, hence the need for this Update. During 2011 and early 2012, members of the WAO Special Committee on Anaphylaxis independently searched for and selected relevant publications, which were then collated and independently ranked for inclusion in the Update.

Here, we recapitulate the evidence-based recommendations in the Guidelines and support them with additional recent references. The Update is intended for use in conjunction with the Guidelines and the references cited therein.[1]

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