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. 2024 Nov 29;14(12):e70009. doi: 10.1002/clt2.70009

10 practical priorities to prevent and manage serious allergic reactions: GA2LEN ANACare and EFA Anaphylaxis Manifesto

Antonella Muraro 1,✉, Debra de Silva 2, Marcia Podesta 3, Aikaterini Anagnostou 4,5, Victoria Cardona 6, Susanne Halken 7, Pete Smith 8, Luciana Kase Tanno 9, Paul Turner 10, Margitta Worm 11, Montserrat Alvaro‐Lozano 12, Stefania Arasi 13, Anna Asarnoj 14, Simona Barni 15, Kirsten Beyer 11,16, Lucy A Bilaver 17, Andrew Bird 18, Roberta Bonaguro 1, Helen A Brough 19, R Sharon Chinthrajah 20, Emma E Cook 21, Céline Demoulin 22, Antoine Deschildre 23, Timothy E Dribin 24, Motohiro Ebisawa 25, Montserrat Fernandez‐Rivas 26, Alessandro Fiocchi 27, David M Fleischer 28, Eleanor Garrow 29, Jennifer Gerdts 30, Mattia Giovannini 15,31, Kirsi M Järvinen 32, Mary Kelly 33, Edward F Knol 34, Gideon Lack 19, Francesca Lazzarotto 1, Thuy‐My Le 35, Stephanie Leonard 36, Jay Lieberman 37, Michael Makris 38, Lianne Mandelbaum 39, Mary Jane Marchisotto 40, Gustavo Andres Marino 41, Francesca Mori 15, Caroline Nilsson 42,43, Anna Nowak‐Wegrzyn 44,45, Mikaela Odemyr 46, H N G Oude Elberink 47, Kati Palosuo 48, Nandinee Patel 10, Jennifer Pier 49, Sung Poblete 50, Rima Rachid 51, Pablo Rodríguez del Río 52, Maria Said 53, Hugh A Sampson 54, Angel Sánchez Sanz 55, Sabine Schnadt 56, Fallon Schultz 57, Alice Toniolo 1, Julia E M Upton 58, Carina Venter 59, Brian P Vickery 60, Berber Vlieg‐Boerstra 61, Julie Wang 54, Graham Roberts 62,63,64,65, Torsten Zuberbier 11,66; GA2LEN ANACare Centres and EFA
PMCID: PMC11606857  PMID: 39614094

Abstract

This Anaphylaxis Manifesto calls on communities to prioritise 10 practical actions to improve the lives of people at risk of serious allergic reactions. The Global Allergy and Asthma European Network and the European Federation of Allergy and Airways Diseases Patients' Associations (EFA) compiled patient‐centric priorities. We used qualitative consensus methods, research evidence and feedback from over 200 patient groups, stakeholder organisations and healthcare professionals. We encourage healthcare, education and food organisations to collaborate with people at risk of serious allergic reactions to tackle safety, anxiety and financial burdens for individuals and societies. Key priorities for prevention include awareness‐raising campaigns for the public and professionals, school and workplace initiatives and mandatory precautionary allergen labels on food. Priorities for improving immediate and long‐term management include educating healthcare professionals, patients and schools about when and how to use adrenaline, funding two approved adrenaline devices for everyone at risk, and facilitating access to allergy specialists. Integrated care pathways should include clinical and non‐clinical management options such as individualised risk assessment and quality of life assessment, self‐management plans, dietetic and psychosocial support and peer support. Organisations around the world are committing to work together towards these priorities.

Keywords: adrenaline, allergy, anaphylaxis, hypersensitivity

1. WHY IDENTIFY PRIORITIES?

Anaphylaxis is a serious hypersensitivity reaction. Hypersensitivity means that the body's immune system reacts to a substance in an exaggerated or inappropriate way. The symptoms of anaphylaxis range from less to more severe, and can be life‐threatening. This Manifesto focuses on anaphylaxis resulting from allergic reactions (IgE‐mediated induced anaphylaxis). To be clear for laypeople, we use the term ‘serious allergic reactions’ instead of IgE‐mediated induced anaphylaxis. We describe high impact actions that communities can take to support people living with the risk of serious allergic reactions. Such reactions are common, cost countries millions each year and affect people's physical and mental wellbeing and productivity. 1 , 2 , 3 , 4

The European Federation of Allergy and Airways Diseases Patients' Associations (EFA) represents 46 patient organisations. It partnered with the Global Allergy and Asthma European Network (GA2LEN) to create this Manifesto. GA2LEN, is a consortium of research and clinical centres specialising in allergic disease, including 39 accredited Anaphylaxis Centres of Reference and Excellence (ANACare) which undertake anaphylaxis education, research and advocacy around the world.

This Manifesto describes practical, actionable priorities that we are advocating for over the next 5 years. We emphasise community‐based solutions that involve affected people, families, primary healthcare and schools because successful prevention and management goes beyond allergy specialists alone. We do not detail treatment such as immunotherapy for the underlying conditions. This is important, but we want to widen the conversation. The core principle is that we can achieve more together than by isolated efforts. We want to break down silos between sectors and regions to prioritise global prevention, including modifying risk factors and considering social and cultural determinants.

The Manifesto is written in an easy‐to‐read style for patients and families, people in non‐clinical roles, policymakers and healthcare workers beyond the allergy speciality. We aim to spark discussion and inspire teams to collaborate on priorities that resonate most with them.

2. HOW DID WE IDENTIFY PRIORITIES?

A 12‐person working group with patient organisations, allergy specialists, immunologists, paediatricians, educators, primary care, researchers and others oversaw the process to build consensus on patient‐centric advocacy priorities. We consulted directly with over 200 organisations representing thousands of stakeholders. A panel of 67 international experts reviewed and signed off the priorities.

At the beginning of the process, we extracted areas for development from recent guidelines, reviews of published evidence and primary research. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 We asked 85 GA2LEN and EFA stakeholder organisations to identify gaps in current practice and actions that would make the greatest difference in people's lives. We had meetings and telephone calls with experts from over 30 countries. We canvassed opinions at conferences and six targeted meetings during 2023 and 2024. We involved a qualitative researcher who used grounded theory and content analysis to identify the most common priorities from all submissions. 15 , 16 There was significant consensus across all stakeholders, so a Delphi method was not needed to reach agreement.

The working group used a consensus process at a series of meetings to review all feedback and confirm the top 10 priorities. The draft priorities were reviewed and formally voted on by 80 people at an international conference. Final validation came from 67 organisational stakeholders including EFA, international patient organisations and GA2LEN organisations and members (Box 1).

Box 1 Methods used to identify practical priorities for supporting people at risk.

1.

  • Submissions from 39 ANACare clinical and research centres, EFA (representing 46 patient organisations in 28 countries), 10 patient organisations and wider stakeholders.

  • Literature review of gaps in diagnosis and management reported in systematic reviews, primary research studies and recent guidelines.

  • Meetings and telephone calls to gain feedback from multidisciplinary and multi‐professional teams from 30+ countries, including patients and families,

  • Content analysis and grounded theory approach to identify themes across all submissions, conversations and meeting notes.

  • Reviewing and voting for priorities by 80 experts at 2024 GA2LEN ANACare Anaphylaxis and Food Allergy conference

  • Oversight and final prioritisation by 12‐person expert panel working group using a consensus approach, taking into account all feedback on draft Manifesto from over 200 international stakeholders.

  • Written review and validation of priorities from a panel of 67 experts.

3. WHAT ARE SERIOUS ALLERGIC REACTIONS?

Patient organisations said that it was important to put the priorities in context by providing a simple description of what serious allergic reactions are and why it is important to tackle them. The next sections summarise this briefly. We do not cover all details or nuances.

An allergic reaction occurs when a person's immune system mistakenly perceives a foreign substance or food as being harmful. The immune system responds by releasing chemicals to try to tackle the substance. This causes the symptoms of an allergic reaction. Serious allergic reactions are called IgE‐mediated anaphylaxis.

There are various definitions of serious allergic reactions. 17 , 18 , 19 , 20 A refined consensus definition is in press. 21 For the purpose of this paper, we consider a serious allergic reaction to be when serious symptoms develop within minutes or hours of exposure to an allergen. The symptoms can range from what may initially seem mild (e.g. rash) to very severe. Symptoms can become more severe quickly. Very severe reactions can be life‐threatening, but many people experience much less severe symptoms. More than one body system is usually affected, including the skin, breathing system, digestive tract, and heart and blood vessels. Examples of symptoms include itchy skin, rash, hives/welts, difficulty breathing, wheezing, cough, swelling of the tongue, lips, throat or other parts of the body, difficulty swallowing, abdominal pain, nausea, vomiting, diarrhoea, changes in heart rhythm or blood pressure, flushing, and feeling faint. 22 In other words, anaphylaxis is much broader than ‘anaphylactic shock’.

4. HOW COMMON ARE SERIOUS ALLERGIC REACTIONS?

Allergies are long‐term conditions. People will have periods when they manage their risk without incident and other periods of crisis when they may experience a serious allergic reaction to food, medication, venom, or other substances. Serious allergic reactions are common and affect thousands of people globally each day.

Up to 3%–5% of the population may experience a serious allergic reaction in their lifetime. 23 This means that up to 1 in 20 people may be directly affected, plus their family and supporters. 24 Most statistics are based on large population studies, hospital records or national registries. The figures may still underestimate the numbers due to misdiagnosis and misclassification. 25

There may be over 5 million serious allergic reactions across the world each year. 26 , 27 25%–50% of people who experience a serious allergic reaction have one or more further episodes. 28 Serious allergic reactions are more common in children, especially those aged under 5 years, whereas fatal reactions are more common in adults, especially those aged 18–30 years. 29 , 30 , 31

Serious allergic reactions are not usually fatal, but there are an estimated 8000 deaths per year across the world related to various allergens. 32 To put this in perspective, each year about 1.2 million people die in vehicle accidents globally. 33 , 34

In recent decades, there has been an increase in the number of reported serious allergic reactions and associated emergency department visits and hospital admissions. 35 , 36 , 37 It is unclear whether this is because reactions are becoming more common or because people are better at identifying them. Statistics from the UK, USA and Europe suggest that death due to an allergic reaction is not increasing. 38

5. WHAT CAUSES SERIOUS ALLERGIC REACTIONS?

Foods, medicines and venom (such as bee and wasp stings) are the most common triggers of serious allergic reactions. 39 , 40 , 41 , 42 , 43 , 44 Food is the most common cause of serious allergic reactions in children. Medications and venom are the most common causes in adults. 28 , 45

In ‘westernised’ countries, the most common food triggers in children are peanuts, tree nuts, cow's milk and hen's eggs. 46 , 47 In adults, common food triggers include shellfish and wheat. 48 , 49 There are many other possible food and non‐food triggers, and they differ between regions. 50 , 51 , 52 , 53 Examples of other triggers include antibiotics, general anaesthetic, painkillers and latex. 35 , 54

6. WHAT IS THE IMPACT OF SERIOUS ALLERGIC REACTIONS?

Serious allergic reactions have immediate physical effects, such as difficulty breathing, vomiting and abdominal pain. Most physical symptoms only last for a short time, but can cause discomfort and anxiety for the person and their family. As previously stated, fatal reactions are rare, with 1–2 deaths per million people per year. 55

Serious allergic reactions can impact on the quality of life of people affected and those around them. 56 , 57 , 58 , 59 People with allergies may feel anxious about having a reaction and limit their social activities and behaviours. 60 , 61 , 62 They may feel stigma and avoid eating out or travelling. They may avoid talking about past experiences. People with a food allergy may avoid certain foods or buy substitutes, which can be costly and add extra preparation time. 63 In children and people with multiple food allergies, avoiding food groups may affect nutrition. 64 People from less advantaged socio‐economic groups may bear a higher burden because managing allergies may be more difficult or costly for them. 65

Family members of people at risk are often upset and worried when someone has a serious allergic reaction. They may also feel anxious and protective when helping people manage their risk. They may alter their own behaviours and activities to adapt to their loved one's needs.

Serious allergic reactions also impact on health and education services. Around one quarter of affected people experience their first serious allergic reaction at school or preschool/kindergarten. 66 Healthcare and education professionals therefore need to learn how to minimise the risk and how to identify and manage serious allergic reactions, as well as make sure emergency treatment is available.

Researchers have estimated that each developed country spends millions of currency every year on emergency department visits, hospital admissions and other direct health costs for serious allergic reactions. 67 , 68 , 69 , 70 , 71 , 72 These costs are increasing, in line with higher rates of serious allergic reactions. 73 There are also economic impacts from reduced quality of life and lost productivity at work and school. Families bear around half of the cost, with the other half covered by healthcare services, insurance, employers and governments. 74

There are also costs and challenges for the food, hospitality and travel industries. This includes the expense of identifying, labelling and segregating allergenic ingredients and complying with regulations to ensure products are safely prepared and handled. 75

7. HOW ARE SERIOUS ALLERGIC REACTIONS DIAGNOSED AND MANAGED?

Many clinical guidelines and practice parameters describe ways to diagnose and manage serious allergic reactions in an emergency, as well as longer‐term management and prevention. 76 , 77 , 78 Most guidelines are based on expert opinion and clinical experience because there is limited high quality research comparing treatment approaches. 79 , 80

The exact approaches for diagnosis and emergency management differ by region. As a general summary, a clinician will usually diagnose a serious allergic reaction based on reviewing an individual's symptoms and history, sometimes with follow up blood tests weeks later. 81

The recommended emergency treatment during a serious allergic reaction initially includes 82 , 83 , 84 :

  • distancing the person from the allergen where possible (e.g. removing latex or insect)

  • encouraging people to lie flat with their legs raised to help circulation, or sit up if they are wheezing

  • using adrenaline (also called epinephrine) as the first‐line treatment if symptoms warrant it or if in any doubt because symptoms can escalate rapidly

  • using antihistamines for skin symptoms if needed

Adrenaline is usually injected into the outer upper thigh muscle, either by the person themselves, a caregiver, or a healthcare or education professional. Alternatives such as adrenaline nasal sprays are becoming available in some countries.

People are encouraged to call for emergency advice as soon as they start experiencing symptoms. In some regions, selected individuals may be advised to monitor symptoms in the community, whereas in other countries, everyone is asked to go to the emergency department, especially after using adrenaline. Most serious allergic reactions respond to one to two doses of adrenaline, but more doses may be needed. For urgent escalation, intravascular fluid replacement may be needed then intravenous adrenaline. 85 , 86

Guidelines are less definitive about the ‘must dos’ for the ongoing management of people at risk of serious allergic reactions. There is less research on the effectiveness of initiatives, apart from for people with food allergies. In general, studies suggest that people should have a written plan for ongoing management and emergencies based on individualised assessments of risk. 87 They should be trained in how to avoid allergens inside and outside of the home and be prescribed approved adrenaline self‐administration devices to keep on hand. 88 They should be supported to address other conditions such as asthma because poorly controlled asthma can increase the risk of serious allergic reactions. 89 They should have access to accurate information about the presence of food allergens on pre‐packaged and non‐pre‐packaged food. 90 Research also suggests considering options that may help targeted people better tolerate allergens, such as allergen‐specific immunotherapy and biological drugs. 91 , 92

8. WHAT ARE THE KEY CHALLENGES AND PRIORITIES?

A panel of other international experts previously identified research priorities for serious allergic reactions. 93 The research priorities were largely clinically‐focused such as improving diagnostic criteria, identifying ways to test for anaphylaxis, standardising the criteria for admitting people to hospital and observing them, and identifying best practices in immunotherapy to help people increase tolerance to allergens. We support all of these priorities.

To add to this, GA2LEN, EFA and international patient organisations aimed to highlight practical actions that patient groups, educational institutions, healthcare professionals, the food and transport industries, employers and policymakers can take or campaign for to improve the lives of people with allergies. There was significant consensus on the issues raised in evidence reviews and expert submissions to our prioritisation process in 2023 and 2024.

We identified the top 10 practical priorities that experts and evidence suggested may make the greatest difference (Box 2). We focused on things that are best done collaboratively, recognising that effort is needed at the level of individuals, organisations and wider systems.

Box 2 10 practical priorities to help prevent and manage serious allergic reactions.

1.

Target group Prevention Management
Patients and the public 1. Focus on increasing awareness about how to identify, respond to and proactively manage serious allergic reactions and triggers. Target groups include people with allergies (especially adolescents and young adults), their families, the public, school personnel, people working in food and hospitality industries and employers. This may include public information campaigns with social media, influencers and celebrities, games, posters, school lessons and other novel approaches. It may also include education sessions, videos, leaflets and posters for target groups and practical ways to support people who may experience anxiety and bullying as a result of their allergy 2. Empower people to help themselves by coproducing a template for a consistent easy to read/infographic self‐management plan for people managing allergies, including clear guidance about the symptoms of serious allergic reactions and when and how to use adrenaline
Healthcare professionals 3. Train existing and future healthcare professionals, including those working in primary and community care and emergency physicians, to proactively support people at risk. Training is needed to support both prevention and management, including how to identify and manage serious allergic reactions, indications for adrenaline and other treatments, the importance of prescribing and showing people when and how to use adrenaline devices, and referring to an allergy specialist and psychosocial support 4. Upskill health professionals to use quality of life assessments and validated risk assessments routinely, including in primary care and community settings. Empower professionals to direct people to the wealth of resources available, including community peer support groups
Wider systems 5. Implement legal and healthcare policies such that serious allergic reactions/anaphylaxis is categorised as a medical condition requiring proactive management. This will help people at risk maintain their right to be included and not discriminated against in all aspects of society, including education and work 7. Improve access to and legal oversight of approved adrenaline devices, so that patients, nurses, school staff and community workers feel confident using adrenaline quickly when other specialists are not present to oversee. This includes publicly funding and routinely prescribing two adrenaline self‐administration devices for people at risk and improving global access to adrenaline in health, education, work and appropriate public settings
6. Implement evidence‐based integrated care pathways across healthcare systems so everyone at risk of a serious allergic reaction can easily access risk assessment, education, dietetic support, diagnosis, treatment and follow‐on care, including immunotherapy if appropriate. This includes investing in multidisciplinary personnel to provide support and using a dashboard of indicators to track progress over time 8. Fund easy access to an evidence‐based package of psychoeducational interventions to address the psychological burden of people living with allergy and their families. This may include online support, individual counselling, group sessions, apps, peer support groups, etc., with evaluation of the most effective approaches and how best to target them to different groups
Food and hospitality industry 9. Educate the food, hospitality and travel industries about food allergy versus intolerance, allergen control and the best ways of communicating allergens to consumers by working closely with patient groups. This may include building business cases around the financial and reputational impact if businesses do not train staff and adapt processes 10. Legislate for consistent food and hospitality industry policies to improve allergen control and communication processes. This includes considering mandatory food allergen labelling using clear wording constructed alongside patient groups (precautionary allergen labelling)
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We recognise that clinical and legal approaches vary in different countries and regions. These 10 priorities do not seek to mandate specific interventions, devices, or wording. They call on all of us to work together on raising awareness, making sure that people have access to the support needed and agreeing appropriate approaches for prevention and management that can be adapted to local contexts.

The 10 priorities can be divided into three themes:

  • Raising awareness about how to prevent and manage serious allergic reactions in a wide variety of stakeholders.

  • Ensuring that people have access to and are confident using the most effective treatments during serious allergic reactions.

  • Multi‐faceted approaches to support people at risk in the longer‐term.

Guidelines and studies have already identified these as ‘must do’ activities. We call on partners around the world to collaborate to turn research into practice.

8.1. Theme 1: Train people to recognise and manage serious allergic reactions

A new consensus definition of serious allergic reactions (anaphylaxis) is being published. 21 However, even with agreed criteria, we still need to help people recognise and manage serious allergic reactions. These reactions may not be well recognised in primary healthcare, educational institutions, eating places or even in emergency departments. 94 , 95 , 96 , 97 Patient organisations contributing to the Manifesto said that professionals' lack of awareness of symptoms can leave patients feeling isolated, confused and as though they are not taken seriously.

For this reason, many of our top 10 priorities for action focus on raising awareness amongst the public, education professionals, healthcare professionals and the food industry. This includes improving undergraduate and postgraduate education and ongoing training about allergy and serious allergic reactions for family doctors, nurses, paediatricians, emergency care staff, people working in schools and universities, patients, families, the hospitality industry, eating places and the wider public. Standardised medical record forms with diagnostic prompts and regular anaphylaxis audits may raise awareness in healthcare settings. 98 Primary healthcare settings and the food industry have been under‐represented in previous education or promotional campaigns. 99 There are guidelines summarising effective strategies for schools and childcare settings, but regions need support to help implement these consistently. 100 , 101 , 102

There is scope for greater collaboration among patient organisations and others, including sharing educational resources to reduce duplication. There may be a particular gap in resources tailored to young adults and adults.

8.2. Theme 2: Increase access to and confidence using adrenaline

Guidelines state that people should receive adrenaline as quickly as possible when a serious allergic reaction is suspected. 103 However, many people do not receive adrenaline as the first‐line treatment or do not receive it quickly enough. 88 , 104 Therefore, it is a priority to increase knowledge and confidence in using adrenaline among people with allergies, their families and healthcare and education professionals. It is also a priority to ensure that adrenaline is readily available in health, education, work and appropriate public settings. 105 , 106 , 107 We support using the name adrenaline consistently worldwide, either alone or simultaneously alongside the alternative name epinephrine.

Lives could potentially be saved if people at risk of serious allergic reactions carried an approved adrenaline self‐administration device and were not afraid to use it quickly if symptoms developed. However, research suggests that fear, a lack of confidence and distrust of adrenaline are barriers for people with allergies and healthcare and education professionals. 108 , 109 , 110 , 111 , 112 Of those prescribed adrenaline autoinjectors, 25%–50% may not carry them routinely. Many say they do not feel confident using them. 113 , 114 Cost can be a significant barrier to prescribing and using adrenaline self‐administration devices. Public financing is needed to ensure equity of access across patient groups and regions.

Good education, repeated at regular intervals, would help to make best use of available devices, including devices like nasal sprays recently or soon to be released. 115 In some regions people may receive a different adrenaline autoinjector from the pharmacy than they were originally prescribed, so it is important to make sure they receive training about any substituted devices. Making education fun through games and videos and involving family, friends, community groups and influencers may be part of a wider educational campaign for children and adolescents. 116

Adrenaline may not be the first medication that healthcare professionals use when people are having a serious allergic reaction, even in the emergency department. 117 Healthcare professionals and those in training therefore need education to understand that adrenaline is a safe and effective first‐line treatment. 118 , 119

Based on research, expert opinion and patient feedback, we propose that it is a priority to 120 , 121 , 122 , 123 :

  • publicly fund prescribing two approved adrenaline self‐administration devices at a time for each person at risk to keep with them

  • make approved adrenaline devices available in kindergartens, schools, universities, workplaces and public places such as cinemas and food courts

  • put legal safeguards and training in place for nurses, teachers and others who need to use adrenaline in an emergency, without specialist supervision

8.3. Theme 3: Invest in prevention and long‐term management

Identifying and treating people experiencing a serious allergic reaction is only part of the solution. Preventing reactions is also a priority, with actions targeting individuals, organisations/sectors and regions.

Up to half of people who experience a serious allergic reaction have a recurrence. It is essential to prescribe them adrenaline self‐administration devices and refer them to an allergy specialist to codevelop a care plan that recognises individual risks. People may also benefit from psychological support to help cope with the anxiety of being at risk or having experienced a reaction in the past. 124

People who are allergic to food should be followed up at regular intervals by a specialist dietitian for guidance on avoidance, prevention of reactions in and outside the home, understanding precautionary allergen labels and maintaining an optimal diet. 125 Follow up by an allergy specialist is also helpful because people may grow out of allergies or better tolerate (food) allergens over time. It is also helpful to let people know about peer support, such as online forums or in‐person support groups where patients share experiences and feel less alone.

Guidelines recommend this sort of follow‐up but it is often not implemented consistently in practice. For example, fewer than half of the people seen in the emergency department with a serious allergic reaction are prescribed adrenaline self‐administration devices for future use. Only around one third are referred to an allergy specialist. 126 Professionals may not be aware of the range of patient support organisations available in the voluntary and community sector. This is why our top 10 priorities include developing more holistic support options, such as integrated care pathways, easy‐to‐use self‐management plans, and easier access to psychosocial support. Although this Manifesto does not delve into specific treatments for underlying conditions, we support expanding immunotherapy and biological therapy in targeted individuals to protect against serious allergic reactions after accidental allergen exposure.

In terms of wider societal change, we advocate for policies and practices that recognise serious allergic reactions as a significant medical condition, requiring adaptations and regulations so people at risk are not disadvantaged or discriminated against.

Food is the most common trigger for serious allergic reactions. The food and hospitality industries have a key role in preparing safe food, including risk assessment, quality control and informing about the presence of food allergens. 127 , 128 Patient groups have raised concerns that voluntary use of precautionary ‘may contain’ labels is not enough to address the presence of food allergens. These groups call for mandatory worldwide standards for labelling allergens in ingredients and potential unintended allergens in pre‐packed and non‐pre‐packed food (precautionary allergen labelling). 129 There are data to quantify allergen reference doses for some foods, but more work is needed here. 130

9. SUMMARY: HOW CAN WE IMPROVE PEOPLE'S LIVES?

GA2LEN and EFA call on all stakeholders to actively tackle the challenges facing people at risk of serious allergic reactions. Box 2 summarises priorities we can address first, working together across sectors and regions. 131 , 132 Our priorities include actions for individuals, organisations and wider systems.

Our call to action is not about reinventing the wheel. It is about highlighting areas that would make a significant difference if patient organisations, healthcare organisations, governments, researchers and the food industry collaborated to address them. What is innovative here is that numerous clinical, research and patient organisations have joined together to call for practical action. This is also a blueprint for regions with emerging allergy epidemics due to lifestyle changes and industrialisation.

Many of our priorities revolve around raising awareness. Wider awareness is essential to help reduce stigma and make it easier to accommodate food service and travel. There is limited evidence about the most effective approaches for public and professional education, so this is a significant gap for future research. Educational and support initiatives have been tried in various communities, and some good work has been done around school campaigns and self‐management plans. 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 However, given the large scale of the issue and the significant cost of serious allergic reactions for both individuals and societies, it is time for more consistent international agreements, templates and campaigns to improve people's wellbeing and save lives. Patient organisations told us that there is scope for patient organisations to work together more across geographies to share good practice, resources and ideas.

Other priorities focus on interventions at the level of healthcare systems or regulatory frameworks. These approaches require resources to implement. Costs would likely be offset by reducing the amount that countries spend caring for people suffering serious allergic reactions, especially when initiatives target those most at risk. 141 , 142 , 143 , 144 , 145 , 146 , 147

Serious allergic reactions vary widely. They differ in clinical presentation, people's susceptibility and the effectiveness of responses. 148 There is no one‐size fits all approach. Personalised strategies are needed for emergency and long‐term management. The key to developing and delivering those personalised approaches is taking action on education, care pathways and legislation (Box 3).

Box 3 Key take home messages.

1.

  1. Serious allergic reactions (IgE‐mediated anaphylaxis) are common, can have a significant impact on physical and mental health and can be costly for governments, employers and families. They are more than just ‘anaphylactic shock’.

  2. There are practical actions that all stakeholders can take right now or campaign for together:

    • Launch publicity campaigns about what serious allergic reactions are and how to treat them for members of the public, patients, family, food industry personnel, healthcare and education professionals and first responders.

    • Make sure that people at risk have easy access to adrenaline, including prescribing and funding approved devices; training patients and professionals about when and how to use adrenaline; and progressing laws around access to adrenaline in public places and legal safeguards for people who administer adrenaline in an emergency.

    • Provide holistic ongoing support, including self‐management plans, risk assessment, psychosocial and dietetic care, integrated care pathways and mandatory precautionary food allergen labelling for ingredients and unintended allergen presence.

  3. If in doubt, use adrenaline quickly when a serious allergic reaction is suspected.

We hope that organisations will use this list of priority areas when considering what to focus on and fund. Individual organisations, collaborations, or regions will not be able to tackle every priority immediately. Groups may focus on one or two areas first, and share their experience widely to spread good practice. For example, over the next 3–5 years GA2LEN ANACare centres have committed to testing integrated care pathway models and creating consistent education resources for healthcare professionals, including those working in primary care. EFA organisations will contribute to these initiatives and work with partners on high profile public health campaigns for patients and the public.

AUTHOR CONTRIBUTIONS

Antonella Muraro: Conceptualization; funding acquisition; methodology; validation; supervision; project administration; writing—review & editing. Debra de Silva: Conceptualization; investigation; writing—original draft; methodology; validation; writing—review & editing; formal analysis; data curation; project administration. Marcia Podesta: Conceptualization; supervision; writing—review & editing. Aikaterini Anagnostou: Writing—review & editing; conceptualization. Victoria Cardona: Conceptualization; writing—review & editing. Susanne Halken: Conceptualization; writing—review & editing. Pete Smith: Conceptualization; writing—review & editing. Luciana Kase Tanno: Conceptualization; writing—review & editing. Paul Turner: Conceptualization; writing—review & editing. Margitta Worm: Conceptualization; writing—review & editing. Montserrat Alvaro‐Lozano: Conceptualization; writing—review & editing. Stefania Arasi: Writing—review & editing. Anna Asarnoj: Writing—review & editing. Simona Barni: Writing—review & editing. Kirsten Beyer: Writing—review & editing. Lucy A. Bilaver: Writing—review & editing. Andrew Bird: Writing—review & editing. Roberta Bonaguro: Writing—review & editing. Helen A. Brough: Writing—review & editing. R. Sharon Chinthrajah: Writing—review & editing. Emma E. Cook: Writing—review & editing. Céline Demoulin: Writing—review & editing. Antoine Deschildre: Writing—review & editing. Timothy E. Dribin: Writing—review & editing. Motohiro Ebisawa: Writing—review & editing. Montserrat Fernandez‐Rivas: Writing—review & editing. Alessandro Fiocchi: Writing—review & editing. David M. Fleischer: Writing—review & editing. Eleanor Garrow: Writing—review & editing. Jennifer Gerdts: Writing—review & editing. Mattia Giovannini: Writing—review & editing. Kirsi M. Järvinen: Writing—review & editing. Mary Kelly: Writing—review & editing. Edward F. Knol: Writing—review & editing. Gideon Lack: Writing—review & editing. Francesca Lazzarotto: Writing—review & editing. Thuy‐My Le: Writing—review & editing. Stephanie Leonard: Writing—review & editing. Jay Lieberman: Writing—review & editing. Michael Makris: Writing—review & editing. Lianne Mandelbaum: Writing—review & editing. Mary Jane Marchisotto: Writing—review & editing. Gustavo Andres Marino: Writing—review & editing. Francesca Mori: Writing—review & editing. Caroline Nilsson: Writing—review & editing. Anna Nowak‐Wegrzyn: Writing—review & editing. Mikaela Odemyr: Writing—review & editing. H. N. G. Oude Elberink: Writing—review & editing. Kati Palosuo: Writing—review & editing. Nandinee Patel: Writing—review & editing. Jennifer Pier: Writing—review & editing. Sung Poblete: Writing—review & editing. Rima Rachid: Writing—review & editing. Pablo Rodríguez del Río: Writing—review & editing. Maria Said: Writing—review & editing. Hugh A. Sampson: Writing—review & editing. Angel Sánchez Sanz: Writing—review & editing. Sabine Schnadt: Writing—review & editing. Fallon Schultz: Validation. Alice Toniolo: Writing—review & editing. Julia E. M. Upton: Writing—review & editing. Carina Venter: Writing—review & editing. Brian P. Vickery: Writing—review & editing. Berber Vlieg‐Boerstra: Writing—review & editing. Julie Wang: Writing—review & editing. Torsten Zuberbier: Supervision. Graham Roberts: Conceptualization; writing—review & editing.

CONFLICT OF INTEREST STATEMENT

A separate file has been provided listing all potential interests of the authors.

ACKNOWLEDGEMENTS

The Global Allergy and Asthma European Network (GA2LEN) contributed funds to draft the manuscript.

Muraro A, de Silva D, Podesta M, et al. 10 practical priorities to prevent and manage serious allergic reactions: GA2LEN ANACare and EFA Anaphylaxis Manifesto. Clin Transl Allergy. 2024;e70009. 10.1002/clt2.70009

Antonella Muraro, Debra de Silva and Marcia Podesta are joint first authors.

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

REFERENCES

  • 1. Cianferoni A, Muraro A. Food‐induced anaphylaxis. Immunol Allergy Clin North Am. 2012;32(1):165‐195. 10.1016/j.iac.2011.10.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Stiles SL, Sanfilippo FM, Loh R, Said M, Clifford RM, Salter SM. Contemporary trends in anaphylaxis burden and healthcare utilisation in Western Australia: a linked data study. World Allergy Organ J. 2023;16(9):100818. 10.1016/j.waojou.2023.100818 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Lee Y, Chang HY, Kim SH, et al. A prospective observation of psychological distress in patients with anaphylaxis. Allergy Asthma Immunol Res. 2020;12(3):496‐506. 10.4168/aair.2020.12.3.496 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Martini M, Di Taranto M, Höfer V, Worm M, Bilò MB. Health‐related quality of life and mental health in drug hypersensitivity reactions and drug‐induced anaphylaxis: a systematic review and meta‐analysis. J Allergy Clin Immunol Pract. 2023;11(6):1876‐1890. 10.1016/j.jaip.2023.03.012 [DOI] [PubMed] [Google Scholar]
  • 5. Muraro A, de Silva D, Halken S, et al. Managing food allergy: GA2LEN guideline 2022. World Allergy Organ J. 2022;15(9):100687. 10.1016/j.waojou.2022.100687 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Turner PJ, Arasi S, Ballmer‐Weber B, et al. Risk factors for serious reactions in food allergy: rapid evidence review with meta‐analysis. Allergy. 2022;77(9):2634‐2652. 10.1111/all.15318 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63 Suppl 86:8‐160. 10.1111/j.1398-9995.2007.01620.x [DOI] [PubMed] [Google Scholar]
  • 8. de Silva D, Rodríguez Del Río P, de Jong NW, et al. Allergen immunotherapy and/or biologicals for IgE‐mediated food allergy: a systematic review and meta‐analysis. Allergy. 2022;77(6):1852‐1862. 10.1111/all.15211 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Zuberbier T, Dörr T, Aberer W, et al. Proposal of 0.5 mg of protein/100 g of processed food as threshold for voluntary declaration of food allergen traces in processed food‐a first step in an initiative to better inform patients and avoid fatal allergic reactions: a GA2LEN position paper. Allergy. 2022;77(6):1736‐1750. 10.1111/all.15167 [DOI] [PubMed] [Google Scholar]
  • 10. Garcia‐Larsen V, Luczynska M, Kowalski ML, et al. Use of a common Food Frequency Questionnaire (FFQ) to assess dietary patterns and their relation to allergy and asthma in Europe: pilot study of the GA2LEN FFQ. Eur J Clin Nutr. 2011;65(6):750‐756. 10.1038/ejcn.2011.15 [DOI] [PubMed] [Google Scholar]
  • 11. Garcia‐Larsen V, Thawer N, Charles D, et al. Dietary intake of flavonoids and ventilatory function in European adults: a GA2LEN Study. Nutrients. 2018;10(1):95. 10.3390/nu10010095 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Michelson KA, Dribin TE, Vyles D, Neuman MI. Trends in emergency care for anaphylaxis. J Allergy Clin Immunol Pract. 2020;8(2):767‐768.e2. 10.1016/j.jaip.2019.07.018 [DOI] [PubMed] [Google Scholar]
  • 13. Muraro A, Clark A, Beyer K, et al. The management of the allergic child at school: EAACI/GA2LEN Task Force on the allergic child at school. Allergy. 2010;65(6):681‐689. 10.1111/j.1398-9995.2010.02343.x [DOI] [PubMed] [Google Scholar]
  • 14. Golden DBK, Wang J, Waserman S, et al. Anaphylaxis: a 2023 practice parameter update. Ann Allergy Asthma Immunol. 2023:S1081–1206(23)01304‐2. 10.1016/j.anai.2023.09.015 [DOI] [PubMed] [Google Scholar]
  • 15. Cho JY, Lee E. Reducing confusion about grounded theory and qualitative content analysis: similarities and differences. Qual Rep. 2014;19(32):1‐20. 10.46743/2160-3715/2014.1028 [DOI] [Google Scholar]
  • 16. de Farias BG, Dutra‐Thomé L, Koller S, de Castro TG. Formulation of themes in qualitative research: logical procedures and analytical paths. Trends Psychol. 2021;29(1):155‐166. 10.1007/s43076-020-00052-0 [DOI] [Google Scholar]
  • 17. Sampson HA, Muñoz‐Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report–Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. J Allergy Clin Immunol. 2006;117(2):391‐397. 10.1016/j.jaci.2005.12.1303 [DOI] [PubMed] [Google Scholar]
  • 18. Simons FE, Ebisawa M, Sanchez‐Borges M, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J. 2015;8(1):32. 10.1186/s40413-015-0080-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Australasian Society of Clinical Immunology and Allergy . ASCIA Guidelines: Acute Management of Anaphylaxis. ASCIA; 2024. [Google Scholar]
  • 20. National Institute for Health and Clinical Excellence . Anaphylaxis: Assessment to Confirm an Anaphylactic Episode and the Decision to Refer After Emergency Treatment for a Suspected Anaphylactic Episode. NICE Clinical Guidelines 134. NICE; 2011. [PubMed] [Google Scholar]
  • 21. Dribin TE, Muraro A, Camargo CA Jr, et al. Anaphylaxis definition, overview, and clinical support tool: 2024 consensus report. In press.
  • 22. Alvarez‐Perea A, Tomás‐Pérez M, Martínez‐Lezcano P, et al. Anaphylaxis in adolescent/adult patients treated in the emergency department: differences between initial impressions and the definitive diagnosis. J Investig Allergol Clin Immunol. 2015;25(4):288‐294. [PubMed] [Google Scholar]
  • 23. Wood RA, Camargo CA, Jr , Lieberman P, et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133(2):461‐467. 10.1016/j.jaci.2013.08.016 [DOI] [PubMed] [Google Scholar]
  • 24. Moen ØL, Opheim E, Trollvik A. Parents experiences raising a child with food allergy; a qualitative review. J Pediatr Nurs. 2019;46:e52‐e63. 10.1016/j.pedn.2019.02.036 [DOI] [PubMed] [Google Scholar]
  • 25. Gonzalez‐Perez A, Aponte Z, Vidaurre CF, Rodriguez LA. Anaphylaxis epidemiology in patients with and patients without asthma: a United Kingdom database review. J Allergy Clin Immunol. 2010;125(5):1098‐1104.e1. 10.1016/j.jaci.2010.02.009 [DOI] [PubMed] [Google Scholar]
  • 26. Höfer V, Dölle‐Bierke S, Francuzik W, et al. Fatal and near‐fatal anaphylaxis: data from the European Anaphylaxis Registry and National Health Statistics. J Allergy Clin Immunol Pract. 2024;12(1):96‐105.e8. 10.1016/j.jaip.2023.09.044 [DOI] [PubMed] [Google Scholar]
  • 27. Dölle‐Bierke S, Höfer V, Francuzik W, et al. Food‐induced anaphylaxis: data from the European Anaphylaxis Registry. J Allergy Clin Immunol Pract. 2023;11(7):2069‐2079.e7. 10.1016/j.jaip.2023.03.026 [DOI] [PubMed] [Google Scholar]
  • 28. Tejedor Alonso MA, Moro‐Moro M, Múgica‐García MV. Epidemiology of anaphylaxis: contributions from the last 10 years. J Investig Allergol Clin Immunol. 2015;25(3):163‐175. [PubMed] [Google Scholar]
  • 29. Tejedor Alonso MA, Moro Moro M, Múgica García MV. Epidemiology of anaphylaxis. Clin Exp Allergy. 2015;45(6):1027‐1039. 10.1111/cea.12418 [DOI] [PubMed] [Google Scholar]
  • 30. Umasunthar T, Leonardi‐Bee J, Hodes M, et al. Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta‐analysis. Clin Exp Allergy. 2013;43(12):1333‐1341. 10.1111/cea.12211 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Tanno LK, Demoly P. Anaphylaxis in children. Pediatr Allergy Immunol. 2020;31 Suppl 26:8‐10. 10.1111/pai.13336 [DOI] [PubMed] [Google Scholar]
  • 32. Ma L, Danoff TM, Borish L. Case fatality and population mortality associated with anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133(4):1075‐1083. 10.1016/j.jaci.2013.10.029 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33. Eurostat . Persons killed in road accidents by age, sex and category of persons involved. 2024. Accessed October 14, 2024. https://ec.europa.eu/eurostat/databrowser/view/tran_sf_roadus/
  • 34. World Health Organization . Road traffic accidents. Key facts. 2023. Accessed October 14, 2024. https://www.who.int/news‐room/fact‐sheets/detail/road‐traffic‐injuries
  • 35. Motosue MS, Li JT, Campbell RL. Anaphylaxis: epidemiology and differential diagnosis. Immunol Allergy Clin North Am. 2022;42(1):13‐25. 10.1016/j.iac.2021.09.010 [DOI] [PubMed] [Google Scholar]
  • 36. Turner PJ, Gowland MH, Sharma V, et al. Increase in anaphylaxis‐related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992‐2012. J Allergy Clin Immunol. 2015;135(4):956‐963.e1. 10.1016/j.jaci.2014.10.021 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37. Lee S, Hess EP, Lohse C, Gilani W, Chamberlain AM, Campbell RL. Trends, characteristics, and incidence of anaphylaxis in 2001‐2010: a population‐based study. J Allergy Clin Immunol. 2017;139(1):182‐188.e2. 10.1016/j.jaci.2016.04.029 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38. Turner PJ, Campbell DE, Motosue MS, Campbell RL. Global trends in anaphylaxis epidemiology and clinical implications. J Allergy Clin Immunol Pract. 2020;8(4):1169‐1176. 10.1016/j.jaip.2019.11.027 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39. Grabenhenrich LB, Dölle S, Moneret‐Vautrin A, et al. Anaphylaxis in children and adolescents: the European Anaphylaxis Registry. J Allergy Clin Immunol. 2016;137(4):1128‐1137.e1. 10.1016/j.jaci.2015.11.015 [DOI] [PubMed] [Google Scholar]
  • 40. Shah RH, Kuder MM, Lang DM. Anaphylaxis to drugs, biological agents, and vaccines. Immunol Allergy Clin North Am. 2022;42(1):121‐144. 10.1016/j.iac.2021.10.001 [DOI] [PubMed] [Google Scholar]
  • 41. Kuruvilla M, Khan DA. Anaphylaxis to drugs. Immunol Allergy Clin North Am. 2015;35(2):303‐319. 10.1016/j.iac.2015.01.008 [DOI] [PubMed] [Google Scholar]
  • 42. Golden DB. Anaphylaxis to insect stings. Immunol Allergy Clin North Am. 2015;35(2):287‐302. 10.1016/j.iac.2015.01.007 [DOI] [PubMed] [Google Scholar]
  • 43. Indolfi C, Dinardo G, Klain A, et al. Sensitization to nsLTP: a retrospective study in an Italian pediatric population over the last decade. J Immunol Res. 2023;2023:4053799. 10.1155/2023/4053799 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44. Demoly P, Adkinson NF, Brockow K, et al. International consensus on drug allergy. Allergy. 2014;69(4):420‐437. 10.1111/all.12350 [DOI] [PubMed] [Google Scholar]
  • 45. Mertes PM, Malinovsky JM, Jouffroy L, et al. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011;21(6):442‐453. [PubMed] [Google Scholar]
  • 46. Montañez MI, Mayorga C, Bogas G, et al. Epidemiology, mechanisms, and diagnosis of drug‐induced anaphylaxis. Front Immunol. 2017;29(8):614. 10.3389/fimmu.2017.00614 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47. Vetander M, Helander D, Flodström C, et al. Anaphylaxis and reactions to foods in children ‐ a population‐based case study of emergency department visits. Clin Exp Allergy. 2012;42(4):568‐577. 10.1111/j.1365-2222.2011.03954.x [DOI] [PubMed] [Google Scholar]
  • 48. Rossi CM, Lenti MV, Di Sabatino A. Adult anaphylaxis: a state‐of‐the‐art review. Eur J Intern Med. 2022;100:5‐12. 10.1016/j.ejim.2022.03.003 [DOI] [PubMed] [Google Scholar]
  • 49. Tham EH, Leung ASY, Pacharn P, et al. Anaphylaxis ‐ lessons learnt when East meets West. Pediatr Allergy Immunol. 2019;30(7):681‐688. 10.1111/pai.13098 [DOI] [PubMed] [Google Scholar]
  • 50. Baseggio Conrado A, Ierodiakonou D, Gowland MH, Boyle RJ, Turner PJ. Food anaphylaxis in the United Kingdom: analysis of national data, 1998‐2018. BMJ. 2021;372:n251. 10.1136/bmj.n251 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51. Institute for Quality and Efficiency in Health Care (IQWiG) . Food Allergies: Anaphylactic Reactions (Anaphylaxis). IQWiG; 2020. [Google Scholar]
  • 52. Umasunthar T, Leonardi‐Bee J, Turner PJ, et al. Incidence of food anaphylaxis in people with food allergy: a systematic review and meta‐analysis. Clin Exp Allergy. 2015;45(11):1621‐1636. 10.1111/cea.12477 [DOI] [PubMed] [Google Scholar]
  • 53. Spolidoro GCI, Amera YT, Ali MM, et al. Frequency of food allergy in Europe: an updated systematic review and meta‐analysis. Allergy. 2023;78(2):351‐368. 10.1111/all.15560 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54. Aun MV, Kalil J, Giavina‐Bianchi P. Drug‐induced anaphylaxis. Immunol Allergy Clin North Am. 2017;37(4):629‐641. 10.1016/j.iac.2017.06.002 [DOI] [PubMed] [Google Scholar]
  • 55. Panesar SS, Javad S, de Silva D, et al. The epidemiology of anaphylaxis in Europe: a systematic review. Allergy. 2013;68(11):1353‐1361. 10.1111/all.12272 [DOI] [PubMed] [Google Scholar]
  • 56. Lange L. Quality of life in the setting of anaphylaxis and food allergy. Allergo J Int. 2014;23(7):252‐260. 10.1007/s40629-014-0029-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57. Shaker MS, Schwartz J, Ferguson M. An update on the impact of food allergy on anxiety and quality of life. Curr Opin Pediatr. 2017;29(4):497‐502. 10.1097/MOP.0000000000000509 [DOI] [PubMed] [Google Scholar]
  • 58. Akeson N, Worth A, Sheikh A. The psychosocial impact of anaphylaxis on young people and their parents. Clin Exp Allergy. 2007;37(8):1213‐1220. 10.1111/j.1365-2222.2007.02758.x [DOI] [PubMed] [Google Scholar]
  • 59. Höfer V, Martini M, Dölle‐Bierke S, Worm M, Bilò MB. Health‐related quality of life in food and venom induced anaphylaxis and role of influencing factors. Clin Exp Allergy. 2023;53(3):295‐306. 10.1111/cea.14268 [DOI] [PubMed] [Google Scholar]
  • 60. Warren CM, Jiang J, Gupta RS. Epidemiology and burden of food allergy. Curr Allergy Asthma Rep. 2020;20(2):6. 10.1007/s11882-020-0898-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61. Brzyski P, Cichocka‐Jarosz E, Tarczoń I, Jedynak‐Wąsowicz U, Tomasik T, Lis G. Health‐related quality of life in children and adolescents after systemic sting reaction. Ann Agric Environ Med. 2019;26(1):103‐108. 10.26444/aaem/93747 [DOI] [PubMed] [Google Scholar]
  • 62. Knibb RC, Huissoon AP, Baretto R, et al. The impact of anaphylaxis on the quality of life and mental health of adults. Clin Exp Allergy. 2023;53(1):121‐125. 10.1111/cea.14249 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 63. Warren CM, Otto AK, Walkner MM, Gupta RS. Quality of life among food allergic patients and their caregivers. Curr Allergy Asthma Rep. 2016;16(5):38. 10.1007/s11882-016-0614-9 [DOI] [PubMed] [Google Scholar]
  • 64. Parlak Z, Gürel Dİ, Soyer ÖU, Şekerel BE, Şahiner ÜM. Nutritional risks in children with food allergy. Turk J Med Sci. 2023;53(4):845‐858. 10.55730/1300-0144.5648 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65. Trogen B, Jacobs S, Wang J. Disparities in the diagnosis and management of anaphylaxis. Curr Allergy Asthma Rep. 2023;23(1):13‐19. 10.1007/s11882-022-01053-y [DOI] [PubMed] [Google Scholar]
  • 66. Baseggio Conrado A, Patel N, Turner PJ. Global patterns in anaphylaxis due to specific foods: a systematic review. J Allergy Clin Immunol. 2021;148(6):1515‐1525.e3. 10.1016/j.jaci.2021.03.048 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 67. Jahnz‐Rozyk K, Raciborski F, Śliwczyński AM, Kłak A, Pinkas J. Anaphylaxis in Poland: the epidemiology and direct costs. Postępy Dermatologii i Alergologii. 2017;34(6):573‐579. 10.5114/pdia.2017.70361 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 68. Dunn JD, Sclar DA. Anaphylaxis: a payor's perspective on epinephrine autoinjectors. Am J Med. 2014;127(1 suppl):S45‐S50. 10.1016/j.amjmed.2013.09.013 [DOI] [PubMed] [Google Scholar]
  • 69. Armstrong N, Wolff R, van Mastrigt G, et al. A systematic review and cost‐effectiveness analysis of specialist services and adrenaline auto‐injectors in anaphylaxis. Health Technol Assess. 2013;17(17):1‐117, v‐vi. 10.3310/hta17170 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 70. Cardoso B, Moscoso T, Morais‐Almeida M, Demoly P, Tanno LK. Economic burden of drug‐induced anaphylaxis: what can we do better? Curr Opin Allergy Clin Immunol. 2022;22(4):234‐241. 10.1097/ACI.0000000000000836 [DOI] [PubMed] [Google Scholar]
  • 71. Flabbee J, Petit N, Jay N, et al. The economic costs of serious anaphylaxis in France: an inquiry carried out by the Allergy Vigilance Network. Allergy. 2008;63(3):360‐365. 10.1111/j.1398-9995.2007.01513.x [DOI] [PubMed] [Google Scholar]
  • 72. Patel DA, Holdford DA, Edwards E, Carroll NV. Estimating the economic burden of food‐induced allergic reactions and anaphylaxis in the United States. J Allergy Clin Immunol. 2011;128(1):110‐115.e5. 10.1016/j.jaci.2011.03.013 [DOI] [PubMed] [Google Scholar]
  • 73. Rudders SA, Arias SA, Camargo CA, Jr . Trends in hospitalizations for food‐induced anaphylaxis in US children, 2000‐2009. J Allergy Clin Immunol. 2014;134(4):960‐962.e3. 10.1016/j.jaci.2014.06.018 [DOI] [PubMed] [Google Scholar]
  • 74. Australasian Society of Clinical Immunology and Allergy (ASCIA) . The Economic Impact of Allergic Disease in Australia: Not to Be Sneezed at. ASCIA; 2007. [Google Scholar]
  • 75. Fong AT, Ahlstedt S, Golding MA, Protudjer JLP. The economic burden of food allergy: what we know and what we need to learn. Curr Treat Options Allergy. 2022;9(3):169‐186. 10.1007/s40521-022-00306-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 76. Muraro A, Worm M, Alviani C, et al. EAACI guidelines: anaphylaxis (2021 update). Allergy. 2022;77(2):357‐377. 10.1111/all.15032 [DOI] [PubMed] [Google Scholar]
  • 77. Cardona V, Ansotegui IJ, Ebisawa M, et al. World Allergy Organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13(10):100472. 10.1016/j.waojou.2020.100472 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 78. Ruëff F, Bauer A, Becker S, et al. Diagnosis and treatment of Hymenoptera venom allergy: S2k Guideline of the German Society of Allergology and Clinical Immunology (DGAKI) in collaboration with the Arbeitsgemeinschaft für Berufs‐ und Umweltdermatologie e.V. (ABD), the Medical Association of German Allergologists (AeDA), the German Society of Dermatology (DDG), the German Society of Oto‐Rhino‐Laryngology, Head and Neck Surgery (DGHNOKC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Allergy and Environmental Medicine (GPA), German Respiratory Society (DGP), and the Austrian Society for Allergy and Immunology (ÖGAI). Allergol Select. 2023;7(1):154‐190. 10.5414/ALX02430E [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 79. Irani AM, Akl EG. Management and prevention of anaphylaxis. F1000Res. 2015;4:F1000 Faculty Rev‐1492. 10.12688/f1000research.7181.1 [DOI] [Google Scholar]
  • 80. Simons FE. Pharmacologic treatment of anaphylaxis: can the evidence base be strengthened? Curr Opin Allergy Clin Immunol. 2010;10(4):384‐393. 10.1097/ACI.0b013e32833c2038 [DOI] [PubMed] [Google Scholar]
  • 81. National Clinical Guideline Centre, UK . Drug Allergy: Diagnosis and Management of Drug Allergy in Adults, Children and Young People. Measuring Serum Tryptase After Suspected Anaphylaxis. NICE Clinical Guidelines, No. 183. National Institute for Health and Care Excellence (NICE); 2014. [PubMed] [Google Scholar]
  • 82. Pumphrey RS. Fatal posture in anaphylactic shock. J Allergy Clin Immunol. 2003;112(2):451‐452. 10.1067/mai.2003.1614 [DOI] [PubMed] [Google Scholar]
  • 83. Tse Y, Rylance G. Emergency management of anaphylaxis in children and young people: new guidance from the Resuscitation Council (UK). Arch Dis Child Educ Pract. 2009;94(4):97‐101. 10.1136/adc.2007.120378 [DOI] [PubMed] [Google Scholar]
  • 84. Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis ‐ a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082‐1123. 10.1016/j.jaci.2020.01.017 [DOI] [PubMed] [Google Scholar]
  • 85. Soar J, Pumphrey R, Cant A, et al. Emergency treatment of anaphylactic reactions ‐ guidelines for healthcare providers. Resuscitation. 2008;77(2):157‐169. 10.1016/j.resuscitation.2008.02.001 [DOI] [PubMed] [Google Scholar]
  • 86. Simons FE, Ardusso LR, Bilò MB, et al. 2012 update: World Allergy Organization guidelines for the assessment and management of anaphylaxis. Curr Opin Allergy Clin Immunol. 2012;12(4):389‐399. 10.1097/aci.0b013e328355b7e4 [DOI] [PubMed] [Google Scholar]
  • 87. Helyeh S, David L, Gary S. Advances in the management of food allergy in children. Curr Pediatr Rev. 2018;14(3):150‐155. 10.2174/1573396314666180508164224 [DOI] [PubMed] [Google Scholar]
  • 88. Sicherer SH, Simons FER, Mahr TA, et al. Epinephrine for first‐aid management of anaphylaxis. Pediatrics. 2017;139(3):e20164006. 10.1542/peds.2016-4006 [DOI] [PubMed] [Google Scholar]
  • 89. Wu TD, Brigham EP, McCormack MC. Asthma in the primary care setting. Med Clin North Am. 2019;103(3):435‐452. 10.1016/j.mcna.2018.12.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 90. Gupta R, Kanaley M, Negris O, Roach A, Bilaver L. Understanding precautionary allergen labeling (PAL) preferences among food allergy stakeholders. J Allergy Clin Immunol Pract. 2021;9(1):254‐264.e1. 10.1016/j.jaip.2020.09.022 [DOI] [PubMed] [Google Scholar]
  • 91. Dhami S, Panesar SS, Roberts G, et al. Management of anaphylaxis: a systematic review. Allergy. 2014;69(2):168‐175. 10.1111/all.12318 [DOI] [PubMed] [Google Scholar]
  • 92. de Silva D, Singh C, Muraro A, et al. Diagnosing, managing and preventing anaphylaxis: systematic review. Allergy. 2021;76(5):1493‐1506. 10.1111/all.14580 [DOI] [PubMed] [Google Scholar]
  • 93. Dribin TE, Schnadower D, Wang J, et al. Anaphylaxis knowledge gaps and future research priorities: a consensus report. J Allergy Clin Immunol. 2022;149(3):999‐1009. 10.1016/j.jaci.2021.07.035 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 94. Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30(8):1144‐1150. 10.1046/j.1365-2222.2000.00864.x [DOI] [PubMed] [Google Scholar]
  • 95. Shen Y, Li L, Grant J, et al. Anaphylactic deaths in Maryland (United States) and Shanghai (China): a review of forensic autopsy cases from 2004 to 2006. Forensic Sci Int. 2009;186(1‐3):1‐5. 10.1016/j.forsciint.2008.12.007 [DOI] [PubMed] [Google Scholar]
  • 96. Meyran D, Cassan P, Nemeth M, et al. The ability of first aid providers to recognize anaphylaxis: a scoping review. Cureus. 2023;15(7):e41547. 10.7759/cureus.41547 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 97. Dribin TE, Castells M. Anaphylaxis: data gaps and research needs. Immunol Allergy Clin North Am. 2022;42(1):187‐200. 10.1016/j.iac.2021.10.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 98. Vamvakaris K, Koumpoura A, Farmaki M, et al. Diagnosis, management and prescription practices of adrenaline in children with food‐induced anaphylaxis: audit in a specialized pediatric allergy department. J Personalized Med. 2022;12(9):1477. 10.3390/jpm12091477 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 99. Alvarez‐Perea A, Tanno LK, Baeza ML. How to manage anaphylaxis in primary care. Clin Transl Allergy. 2017;7(1):45. 10.1186/s13601-017-0182-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 100. Vale S, Smith J, Said M, Mullins RJ, Loh R. ASCIA guidelines for prevention of anaphylaxis in schools, pre‐schools and childcare: 2015 update. J Paediatr Child Health. 2015;51(10):949‐954. 10.1111/jpc.12962 [DOI] [PubMed] [Google Scholar]
  • 101. Vale S, Netting MJ, Ford LS, Tyquin B, McWilliam V, Campbell DE. Anaphylaxis management in Australian schools: review of guidelines and adrenaline autoinjector use. J Paediatr Child Health. 2019;55(2):143‐151. 10.1111/jpc.14307 [DOI] [PubMed] [Google Scholar]
  • 102. US Centers for Disease Control and Prevention (CDC) . Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. US Department of Health and Human Services; 2013. [Google Scholar]
  • 103. Whyte AF, Soar J, Dodd A, Hughes A, Sargant N, Turner PJ. Emergency treatment of anaphylaxis: concise clinical guidance. Clin Med. 2022;22(4):332‐339. 10.7861/clinmed.2022-0073 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 104. Storey P, Fitzharris P. Adrenaline in anaphylaxis: overtreatment in theory, undertreatment in reality. Postgrad Med J. 2015;91(1071):1‐2. 10.1136/postgradmedj-2014-133185 [DOI] [PubMed] [Google Scholar]
  • 105. Ponda P, Russell AF, Yu JE, et al. Access barriers to epinephrine autoinjectors for the treatment of anaphylaxis: a survey of practitioners. J Allergy Clin Immunol Pract. 2021;9(10):3814‐3815.e4. 10.1016/j.jaip.2021.05.028 [DOI] [PubMed] [Google Scholar]
  • 106. Tanno LK, Demoly P. Action plan to ensure global availability of adrenaline autoinjectors. J Investig Allergol Clin Immunol. 2020;30(2):77‐85. 10.18176/jiaci.0346 [DOI] [PubMed] [Google Scholar]
  • 107. Russell AF, Bingemann TA, Cooke AT, et al. The need for required stock epinephrine in all schools: a work group report of the AAAAI Adverse Reactions to Foods Committee. J Allergy Clin Immunol Pract. 2023;11(4):1068‐1082.e1. 10.1016/j.jaip.2022.12.047 [DOI] [PubMed] [Google Scholar]
  • 108. Song TT, Worm M, Lieberman P. Anaphylaxis treatment: current barriers to adrenaline auto‐injector use. Allergy. 2014;69(8):983‐991. 10.1111/all.12387 [DOI] [PubMed] [Google Scholar]
  • 109. Simons FE, Clark S, Camargo CA Jr. Anaphylaxis in the community: learning from the survivors. J Allergy Clin Immunol. 2009;124(2):301‐306. 10.1016/j.jaci.2009.03.050 [DOI] [PubMed] [Google Scholar]
  • 110. Wahl A, Stephens H, Ruffo M, Jones AL. The evaluation of a food allergy and epinephrine autoinjector training program for personnel who care for children in schools and community settings. J Sch Nurs. 2015;31(2):91‐98. 10.1177/1059840514526889 [DOI] [PubMed] [Google Scholar]
  • 111. Foster AA, Campbell RL, Lee S, Anderson JL. Anaphylaxis preparedness among preschool staff before and after an educational intervention. J Allergy. 2015;2015:231862‐231865. 10.1155/2015/231862 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 112. Carrillo‐Martin I, Caminati M, Tanno LK, Gonzalez‐Estrada A. Self‐injectable epinephrine: doctors' attitude and patients' adherence in real‐life. Curr Opin Allergy Clin Immunol. 2020;20(5):474‐481. 10.1097/ACI.0000000000000664 [DOI] [PubMed] [Google Scholar]
  • 113. Parke L, Senders AS, Bindslev‐Jensen C, et al. Adherence to adrenaline autoinjector prescriptions in patients with anaphylaxis. Clin Transl Allergy. 2019;9(1):59. 10.1186/s13601-019-0297-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 114. Gold MS, Sainsbury R. First aid anaphylaxis management in children who were prescribed an epinephrine autoinjector device (EpiPen). J Allergy Clin Immunol. 2000;106(1 Pt 1):171‐176. 10.1067/mai.2000.106041 [DOI] [PubMed] [Google Scholar]
  • 115. Umasunthar T, Procktor A, Hodes M, et al. Patients' ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial. Allergy. 2015;70(7):855‐863. 10.1111/all.12628 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 116. Marrs T, Lack G. Why do few food‐allergic adolescents treat anaphylaxis with adrenaline? Reviewing a pressing issue. Pediatr Allergy Immunol. 2013;24(3):222‐229. 10.1111/pai.12013 [DOI] [PubMed] [Google Scholar]
  • 117. Li X, Ma Q, Yin J, et al. A clinical practice guideline for the emergency management of anaphylaxis. Front Pharmacol. 2022;13:845689. 10.3389/fphar.2022.845689 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 118. Dondi A, Calamelli E, Scarpini S, et al. Triage grading and correct diagnosis are critical for the emergency treatment of anaphylaxis. Children. 2022;9(12):1794. 10.3390/children9121794 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 119. Dribin TE, Waserman S, Turner PJ. Who needs epinephrine? Anaphylaxis, autoinjectors, and parachutes. J Allergy Clin Immunol Pract. 2023;11(4):1036‐1046. 10.1016/j.jaip.2023.02.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 120. Moss J, Jani Y, Edwards B, Tomlin S, Rashed AN. Pharmacokinetic and pharmacodynamic evidence of adrenaline administered via auto‐injector for anaphylactic reactions: a review of literature. Br J Clin Pharmacol. 2021;87(3):816‐824. 10.1111/bcp.14438 [DOI] [PubMed] [Google Scholar]
  • 121. Kraft M, Dölle‐Bierke S, Turner PJ, et al. EAACI Task Force Clinical epidemiology of anaphylaxis: experts' perspective on the use of adrenaline autoinjectors in Europe. Clin Transl Allergy. 2020;10(1):12. 10.1186/s13601-020-00317-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 122. Sato S, Kainuma K, Noda T, et al. Evaluation of adrenaline auto‐injector prescription profiles: a population‐based, retrospective cohort study within the National Insurance Claims Database of Japan. Allergol Int. 2022;71(3):354‐361. 10.1016/j.alit.2022.02.002 [DOI] [PubMed] [Google Scholar]
  • 123. Fernandes M, Lourenço T, Spínola Santos A, Pereira Barbosa M. Analysis of adrenaline autoinjectors acquisition in Portugal over 15 years. Eur Ann Allergy Clin Immunol. 2023;55(1):29‐34. 10.23822/EurAnnACI.1764-1489.213 [DOI] [PubMed] [Google Scholar]
  • 124. Rudders SA, Banerji A, Vassallo MF, Clark S, Camargo JC. Trends in pediatric emergency department visits for food‐induced anaphylaxis. J Allergy Clin Immunol. 2010;126(2):385‐388. 10.1016/j.jaci.2010.05.018 [DOI] [PubMed] [Google Scholar]
  • 125. Durban R, Groetch M, Meyer R, et al. Dietary management of food allergy. Immunol Allergy Clin North Am. 2021;41(2):233‐270. 10.1016/j.iac.2021.01.009 [DOI] [PubMed] [Google Scholar]
  • 126. Burnell FJ, Keijzers G, Smith P. Review article: quality of follow‐up care for anaphylaxis in the emergency department. Emerg Med Australas. 2015;27(5):387‐393. 10.1111/1742-6723.12458 [DOI] [PubMed] [Google Scholar]
  • 127. Skypala IJ. Food‐induced anaphylaxis: role of hidden allergens and cofactors. Front Immunol. 2019;10:673. 10.3389/fimmu.2019.00673 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 128. Pouessel G, Turner PJ, Worm M, et al. Food‐induced fatal anaphylaxis: from epidemiological data to general prevention strategies. Clin Exp Allergy. 2018;48(12):1584‐1593. 10.1111/cea.13287 [DOI] [PubMed] [Google Scholar]
  • 129. Muraro A, Hoffmann‐Sommergruber K, Holzhauser T, et al. EAACI Food Allergy and Anaphylaxis Guidelines. Protecting consumers with food allergies: understanding food consumption, meeting regulations and identifying unmet needs. Allergy. 2014;69(11):1464‐1472. 10.1111/all.12453 [DOI] [PubMed] [Google Scholar]
  • 130. Fiocchi A, Risso D, DunnGalvin A, et al. Food labeling issues for serious food allergic patients. World Allergy Organ J. 2021;14(10):100598. 10.1016/j.waojou.2021.100598 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 131. Wallace DV. Knowledge gaps in the diagnosis and management of anaphylaxis. Ann Allergy Asthma Immunol. 2023;131(2):151‐169. 10.1016/j.anai.2023.05.010 [DOI] [PubMed] [Google Scholar]
  • 132. Sala‐Cunill A, Cardona V. Anaphylaxis viewed by experts: unmet needs. Curr Opin Allergy Clin Immunol. 2021;21(5):435‐441. 10.1097/ACI.0000000000000771 [DOI] [PubMed] [Google Scholar]
  • 133. Yıldırım A, Haney MO. Effects of training on teachers' food allergy and anaphylaxis management self‐efficacy levels. Allergol Immunopathol. 2023;51(4):158‐163. 10.15586/aei.v51i4.849 [DOI] [PubMed] [Google Scholar]
  • 134. Knibb RC, Alviani C, Garriga‐Baraut T, et al. The effectiveness of interventions to improve self‐management for adolescents and young adults with allergic conditions: a systematic review. Allergy. 2020;75(8):1881‐1898. 10.1111/all.14269 [DOI] [PubMed] [Google Scholar]
  • 135. Gonzalez‐Mancebo E, Gandolfo‐Cano MM, Trujillo‐Trujillo MJ, et al. Analysis of the effectiveness of training school personnel in the management of food allergy and anaphylaxis. Allergol Immunopathol. 2019;47(1):60‐63. 10.1016/j.aller.2018.05.005 [DOI] [PubMed] [Google Scholar]
  • 136. Dumeier HK, Richter LA, Neininger MP, et al. Knowledge of allergies and performance in epinephrine auto‐injector use: a controlled intervention in preschool teachers. Eur J Pediatr. 2018;177(4):575‐581. 10.1007/s00431-017-3073-y [DOI] [PubMed] [Google Scholar]
  • 137. Sasaki K, Sugiura S, Matsui T, et al. A workshop with practical training for anaphylaxis management improves the self‐efficacy of school personnel. Allergol Int. 2015;64(2):156‐160. 10.1016/j.alit.2014.10.005 [DOI] [PubMed] [Google Scholar]
  • 138. Sicherer SH, Simons FE. Quandaries in prescribing an emergency action plan and self‐injectable epinephrine for first‐aid management of anaphylaxis in the community. J Allergy Clin Immunol. 2005;115(3):575‐583. 10.1016/j.jaci.2004.12.1122 [DOI] [PubMed] [Google Scholar]
  • 139. Wang J, Sicherer SH, Matsui E, et al. Guidance on completing a written allergy and anaphylaxis emergency plan. Pediatrics. 2017;139(3):e20164005. 10.1542/peds.2016-4005 [DOI] [PubMed] [Google Scholar]
  • 140. Kwen H, Oh PJ. Development and evaluation of a mobile web‐based food allergy and anaphylaxis management educational program for parents of school‐aged children with food allergy: a randomized controlled trial. Asian Nurs Res. 2022;16(5):265‐274. 10.1016/j.anr.2022.10.002 [DOI] [PubMed] [Google Scholar]
  • 141. Simons FE, Ardusso LR, Bilò MB, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7(1):9. 10.1186/1939-4551-7-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 142. Hockenhull J, Elremeli M, Cherry MG, et al. A systematic review of the clinical effectiveness and cost‐effectiveness of Pharmalgen® for the treatment of bee and wasp venom allergy. Health Technol Assess. 2012;16(12):III‐IV, 1‐110. 10.3310/hta16120 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 143. Shaker M, Wallace D, Golden DBK, Oppenheimer J, Greenhawt M. Simulation of health and economic benefits of extended observation of resolved anaphylaxis. JAMA Netw Open. 2019;2(10):e1913951. 10.1001/jamanetworkopen.2019.13951 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 144. Shaker M, Kanaoka T, Feenan L, Greenhawt M. An economic evaluation of immediate vs non‐immediate activation of emergency medical services after epinephrine use for peanut‐induced anaphylaxis. Ann Allergy Asthma Immunol. 2019;122(1):79‐85. 10.1016/j.anai.2018.06.035 [DOI] [PubMed] [Google Scholar]
  • 145. Miles LM, Ratnarajah K, Gabrielli S, et al. Community use of epinephrine for the treatment of anaphylaxis: a review and meta‐analysis. J Allergy Clin Immunol Pract. 2021;9(6):2321‐2333. 10.1016/j.jaip.2021.01.038 [DOI] [PubMed] [Google Scholar]
  • 146. Shaker MS, Greenhawt MJ. Analysis of value‐based costs of undesignated school stock epinephrine policies for peanut anaphylaxis. JAMA Pediatr. 2019;173(2):169‐175. 10.1001/jamapediatrics.2018.4275 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 147. Shaker M, Turner PJ, Greenhawt M. A cost‐effectiveness analysis of epinephrine autoinjector risk stratification for patients with food allergy‐one epinephrine autoinjector or two? J Allergy Clin Immunol Pract. 2021;9(6):2440‐2451.e3. 10.1016/j.jaip.2021.01.007 [DOI] [PubMed] [Google Scholar]
  • 148. Brown SG, Stone SF, Fatovich DM, et al. Anaphylaxis: clinical patterns, mediator release, and severity. J Allergy Clin Immunol. 2013;132(5):1141‐1149.e5. 10.1016/j.jaci.2013.06.015 [DOI] [PubMed] [Google Scholar]

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