Revised Anaphylaxis Diagnostic Guidelines Seen as an Improvement

New research shows a recently revised diagnostic criteria is sufficient for emergency departments to identify and treat anaphylaxis in patients.

The World Allergy Organization (WAO) proposed in 2019 a revision of the anaphylaxis diagnostic criteria proposed in 2006 by the National Institute of Allergy and Infectious Disease/ Food Allergy and Anaphylaxis Network (NIAD/FAAN).

A team, led by Justine M. Ade, MD, Mayo Clinic, assessed the accuracy of the revised clinical criteria in 2019 compared to the original diagnostic criteria in 2006 in data presented during the American Academy of Allergy, Asthma & Immunology (AAAAI) 2021 Virtual Sessions.

The Sample

In the cohort study, the researchers identified a stratified sample of 817 patients presenting to an academic Emergency Department between January 2013 and September 2017. The patients included were identified and sampled based on the presence of ICD-9 or ICD-10 codes associated with an emergency department visit that indicated either anaphylaxis, symptoms potentially secondary to anaphylaxis, or an allergic reaction.

The investigators assessed the diagnostic accuracy of the 2 criteria’s by comparison to expert review by an allergist-immunologist or fellow and calculated test characteristics.

Overall, the 2 criteria’s were very similar, with the addition of severe gastrointestinal symptoms especially with non-food allergens and respiratory compromise with bronchospasm or laryngeal involvement added to the 2016 version of the guidelines.

When properly weighed, the sampling represented a cohort of 2191 patients with a median patient age of 42 years old.

The weighted sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 2006 criteria were 92.6%, 76.9%, 65.3%, and 95.7%, respectively, compared to 93.4%, 72.7%, 61.5%, and 95.9%, respectively for the revised version.

“Despite a select number of cases that may be missed by one criteria or both, the revised NIAID/FAAN clinical criteria have test characteristics very similar to the original NIAID/FAAN criteria and are therefore likely to be useful for the diagnosis of anaphylaxis in the ED,” the authors wrote.

Advocating for better treatment of anaphylaxis and food allergies has been a staple of past AAAAI meetings.

A Look Back at AAAAI 2020

Last year, Dennis K. Ledford, MD, University of South Florida College of Medicine and Division of Allergy and Immunology, explained in an interview with HCPLive® the importance of advocating for anaphylaxis awareness.

Ledford was set to present during a session on anaphylaxis during surgery when the conference was cancelled because of COVID-19, making it 1 of the first medical conferences to be impacted by the pandemic.

“It was to increase awareness of the problem of anaphylaxis around anesthesia or surgery because it's not terribly common, but surgery is a common process,” Ledford said. “And it can be misinterpreted where low blood pressure, for example, is due to the anesthesia and not an anaphylactic reaction.”

The study, “Validation of the revised National Institute of Allergy and Infectious Disease / Food Allergy and Anaphylaxis Network Diagnostic Criteria in Emergency Department Patients,” was published online by AAAAI 21.