Implementation of Anaphylaxis Management Guidelines: A Register-Based Study

BACKGROUND: Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. METHODS: Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. RESULTS: 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. CONCLUSION: There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted

National clinical practice guidelines for food allergy and anaphylaxis:an international assessment

Background: clinical practice guidelines are important tools to promote evidence-based clinical care, but not all countries have the capacity or infrastructure to develop these in-house. The European Academy of Allergy and Clinical Immunology has recently developed guidelines for the prevention, diagnosis and management of food allergy and the management of anaphylaxis. In order to inform dissemination, adaptation and implementation plans, we sought to identify countries that have/do not have national guidelines for food allergy and anaphylaxis.Methods: two reviewers independently searched PubMed to identify countries with guidelines for food allergy and/or anaphylaxis from the inception of this database to December 2016. This was supplemented with a search of the Agency for Healthcare Research and Quality's National Guideline Clearinghouse in order to identify any additional guidelines that may not have been reported in the peer-reviewed literature. Data were descriptively and narratively synthesized.Results: overall, 5/193 (3%) of countries had at least one guideline for food allergy or anaphylaxis. We found that one (1%) country had a national guideline for the prevention of food allergy, three (2%) countries had a guideline for the diagnosis of food allergy and three (2%) countries had a guideline for the management of food allergy. Three (2%) countries had an anaphylaxis guideline.Conclusions: this study concludes that the overwhelming majority of countries do not have any national clinical practice guidelines for food allergy or anaphylaxis

Should adrenaline be used in patients with hemodynamically stable anaphylaxis? Incident case control study nested within a retrospective cohort study

Although adrenaline (epinephrine) is a cornerstone of initial anaphylaxis treatment, it is not often used. We sought to assess whether use of adrenaline in hemodynamically stable patients with anaphylaxis could prevent the development of hypotension. We conducted a retrospective cohort study of 761 adult patients with anaphylaxis presenting to the emergency department (ED) of a tertiary care hospital over a 10-year period. We divided the patients into two groups according to the occurrence of hypotension and compared demographic characteristics, clinical features, treatments and outcomes. Of the 340 patients with anaphylaxis who were normotensive at first presentation, 40 patients experienced hypotension during their ED stay. The ED stay of the hypotension group was significantly longer than that of patients who did not experience hypotension (496 min vs 253 min, P = 0.000). Adrenaline use in hemodynamically stable anaphylaxis patient was independently associated with a lower risk of developing in-hospital occurrence of hypotension: OR, 0.254 [95% CI, 0.091-0.706]. Adrenaline use in hemodynamically stable anaphylaxis patients was associated with a reduced risk of developing in-hospital occurrence of hypotension. Adverse events induced by adrenaline were rare when the intramuscular route was used

Biological Invasions of Begomoviruses: A Case Study of TYLCV and Bemisia tabaci in Oman

This review article provides an in-depth analysis of the biological invasions of begomoviruses, focusing on a prominent case study involving the Tomato Yellow Leaf Curl Virus (TYLCV) and its vector, the whitefly Bemisia tabaci, in the unique agricultural landscape of Oman. Begomoviruses, known for their global impact on crop yields, have become a significant concern in Oman, posing a serious threat to the cultivation of various crops, particularly tomatoes. The review begins by exploring the molecular characteristics and ecological dynamics of TYLCV and Bemisia tabaci, shedding light on the intricate interactions between the virus, the vector, and the host plants. Through a comprehensive analysis of historical data and recent research findings, the article examines the patterns and pathways of invasion, elucidating the factors contributing to the successful establishment and spread of TYLCV in Oman. The impacts of TYLCV invasion on agricultural productivity and crop quality are critically evaluated, providing insights into the specific challenges faced by Omani farmers. Special attention is given to the socio-economic repercussions of TYLCV-induced crop losses, emphasizing the need for adaptive management strategies to mitigate the negative consequences on food security and rural livelihoods. Furthermore, the review assesses the current state of knowledge regarding the management and control of TYLCV and Bemisia tabaci in Oman. It discusses the successes and limitations of existing strategies, ranging from conventional practices to innovative biotechnological approaches, providing a foundation for future research directions and the development of sustainable management practices in the context of biological invasions of begomoviruses in Oman. Overall, this review contributes to a nuanced understanding of the complex interplay between invasive begomoviruses, their vectors, and local agricultural systems, offering valuable insights for researchers, policymakers, and practitioners engaged in crop protection and biosecurity in Oman and beyond