Management of anaphylaxis in primary care: Canadian expert consensus recommendations

Authors

  • S. Waserman,

    1. [Correction added after online publication, 24 June 2010: First author's initial changed from 'D' to 'S'.]
      1Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON; 2Department of Pediatrics, Allergy and Clinical Immunology, University of Ottawa, Ottawa, ON; 3Médecin spécialiste en allergie pédiatrique, Spécialité en allergie et immunologie clinique pédiatrique, Hôpital de Montréal pour enfants, Université McGill, Montreal, QC; 4Department of Medicine, Allergy and Clinical Immunology, McGill University, Montreal, QC; 5Department of Medicine, Clinical Immunology and Allergy, University of British Columbia, Vancouver, BC; 6Department of Pediatrics, Division Clinical Immunology and Allergy, University of Alberta, Edmonton, AB; 7Department of Family Medicine, University of Toronto, Toronto, ON; 8Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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  • 1 Z. Chad,

    1. [Correction added after online publication, 24 June 2010: First author's initial changed from 'D' to 'S'.]
      1Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON; 2Department of Pediatrics, Allergy and Clinical Immunology, University of Ottawa, Ottawa, ON; 3Médecin spécialiste en allergie pédiatrique, Spécialité en allergie et immunologie clinique pédiatrique, Hôpital de Montréal pour enfants, Université McGill, Montreal, QC; 4Department of Medicine, Allergy and Clinical Immunology, McGill University, Montreal, QC; 5Department of Medicine, Clinical Immunology and Allergy, University of British Columbia, Vancouver, BC; 6Department of Pediatrics, Division Clinical Immunology and Allergy, University of Alberta, Edmonton, AB; 7Department of Family Medicine, University of Toronto, Toronto, ON; 8Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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  • 2 M. J. Francoeur,

    1. [Correction added after online publication, 24 June 2010: First author's initial changed from 'D' to 'S'.]
      1Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON; 2Department of Pediatrics, Allergy and Clinical Immunology, University of Ottawa, Ottawa, ON; 3Médecin spécialiste en allergie pédiatrique, Spécialité en allergie et immunologie clinique pédiatrique, Hôpital de Montréal pour enfants, Université McGill, Montreal, QC; 4Department of Medicine, Allergy and Clinical Immunology, McGill University, Montreal, QC; 5Department of Medicine, Clinical Immunology and Allergy, University of British Columbia, Vancouver, BC; 6Department of Pediatrics, Division Clinical Immunology and Allergy, University of Alberta, Edmonton, AB; 7Department of Family Medicine, University of Toronto, Toronto, ON; 8Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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  • 3 P. Small,

    1. [Correction added after online publication, 24 June 2010: First author's initial changed from 'D' to 'S'.]
      1Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON; 2Department of Pediatrics, Allergy and Clinical Immunology, University of Ottawa, Ottawa, ON; 3Médecin spécialiste en allergie pédiatrique, Spécialité en allergie et immunologie clinique pédiatrique, Hôpital de Montréal pour enfants, Université McGill, Montreal, QC; 4Department of Medicine, Allergy and Clinical Immunology, McGill University, Montreal, QC; 5Department of Medicine, Clinical Immunology and Allergy, University of British Columbia, Vancouver, BC; 6Department of Pediatrics, Division Clinical Immunology and Allergy, University of Alberta, Edmonton, AB; 7Department of Family Medicine, University of Toronto, Toronto, ON; 8Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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  • 4 D. Stark,

    1. [Correction added after online publication, 24 June 2010: First author's initial changed from 'D' to 'S'.]
      1Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON; 2Department of Pediatrics, Allergy and Clinical Immunology, University of Ottawa, Ottawa, ON; 3Médecin spécialiste en allergie pédiatrique, Spécialité en allergie et immunologie clinique pédiatrique, Hôpital de Montréal pour enfants, Université McGill, Montreal, QC; 4Department of Medicine, Allergy and Clinical Immunology, McGill University, Montreal, QC; 5Department of Medicine, Clinical Immunology and Allergy, University of British Columbia, Vancouver, BC; 6Department of Pediatrics, Division Clinical Immunology and Allergy, University of Alberta, Edmonton, AB; 7Department of Family Medicine, University of Toronto, Toronto, ON; 8Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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  • 5 T. K. Vander Leek,

    1. [Correction added after online publication, 24 June 2010: First author's initial changed from 'D' to 'S'.]
      1Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON; 2Department of Pediatrics, Allergy and Clinical Immunology, University of Ottawa, Ottawa, ON; 3Médecin spécialiste en allergie pédiatrique, Spécialité en allergie et immunologie clinique pédiatrique, Hôpital de Montréal pour enfants, Université McGill, Montreal, QC; 4Department of Medicine, Allergy and Clinical Immunology, McGill University, Montreal, QC; 5Department of Medicine, Clinical Immunology and Allergy, University of British Columbia, Vancouver, BC; 6Department of Pediatrics, Division Clinical Immunology and Allergy, University of Alberta, Edmonton, AB; 7Department of Family Medicine, University of Toronto, Toronto, ON; 8Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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  • 6 A. Kaplan,

    1. [Correction added after online publication, 24 June 2010: First author's initial changed from 'D' to 'S'.]
      1Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON; 2Department of Pediatrics, Allergy and Clinical Immunology, University of Ottawa, Ottawa, ON; 3Médecin spécialiste en allergie pédiatrique, Spécialité en allergie et immunologie clinique pédiatrique, Hôpital de Montréal pour enfants, Université McGill, Montreal, QC; 4Department of Medicine, Allergy and Clinical Immunology, McGill University, Montreal, QC; 5Department of Medicine, Clinical Immunology and Allergy, University of British Columbia, Vancouver, BC; 6Department of Pediatrics, Division Clinical Immunology and Allergy, University of Alberta, Edmonton, AB; 7Department of Family Medicine, University of Toronto, Toronto, ON; 8Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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  • and 7 M. Kastner 8

    1. [Correction added after online publication, 24 June 2010: First author's initial changed from 'D' to 'S'.]
      1Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON; 2Department of Pediatrics, Allergy and Clinical Immunology, University of Ottawa, Ottawa, ON; 3Médecin spécialiste en allergie pédiatrique, Spécialité en allergie et immunologie clinique pédiatrique, Hôpital de Montréal pour enfants, Université McGill, Montreal, QC; 4Department of Medicine, Allergy and Clinical Immunology, McGill University, Montreal, QC; 5Department of Medicine, Clinical Immunology and Allergy, University of British Columbia, Vancouver, BC; 6Department of Pediatrics, Division Clinical Immunology and Allergy, University of Alberta, Edmonton, AB; 7Department of Family Medicine, University of Toronto, Toronto, ON; 8Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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  • Edited by: Hans-Uwe Simon

Monika Kastner, PhD, Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 155 College Street, Toronto, ON, Canada.
Tel.: 905 515 3107
Fax: 1 866 479 1630
E-mail: monika.kastner@utoronto.ca

Abstract

To cite this article: Waserman S, Chad Z, Francoeur MJ, Small P, Stark D, Vander Leek TK, Kaplan A, Kastner M. Management of anaphylaxis in primary care: Canadian expert consensus recommendations. Allergy 2010; 65: 1082–1092.

Abstract

Background:  Anaphylaxis is often managed inadequately. We used findings from a systematic review of gaps in anaphylaxis management to develop evidence-based recommendations for gaps rated as clinically important by a panel of Canadian allergy experts.

Methods:  The nominal group technique (NGT) consensus methodology was used to develop evidence-based recommendations for the management of anaphylaxis in primary care. Physician-specific gaps from our systematic review were prioritized by consensus meeting participants in two rounds, which involved the rating, discussion, and re-rating of gaps. Using current anaphylaxis guidelines, recommendations were then developed for each category of gaps that were identified by the panel as clinically important.

Results:  Thirty unique physician gaps from the systematic review were categorized according to gaps of knowledge and anaphylaxis practice behaviors. The panel rated diagnosis of anaphylaxis, and when and how to use epinephrine auto-injectors as clinically important knowledge gaps; and rated infrequent or delayed epinephrine administration, low rate of auto-injector prescription, and infrequent or no referrals to allergy specialists after a reaction as important practice behavior gaps. Evidence from four guidelines was used to support the consensus recommendation statements for three resulting categories of gap themes: anaphylaxis management, epinephrine use, and follow-up care.

Conclusion:  We used an NGT consensus methodology to develop an educational resource for primary care physicians and allergists to better understand how to manage patients with anaphylaxis. Next steps include testing our findings against observed data in primary care settings and to develop other strategies or tools to overcome gaps in anaphylaxis management.

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