Divisions of Infectious Disease, Pulmonary, Allergy and Immunology, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Medicine, Section of Allergy, Asthma and Clinical Immunology, William G. Hefner VA Medical Center and Affiliated Institutions, Salisbury, NC.
Crit Care Med. 2021 May 1;49(5):838-857. doi: 10.1097/CCM.0000000000004893.
Anaphylaxis is a rapidly progressive life-threatening syndrome manifesting as pruritus, urticaria, angioedema, bronchospasm and shock. The goal of this synthetic review is to provide a practical, updated approach to the evaluation and management of this disorder and associated complications.
A MEDLINE search was conducted with the MeSH of anaphylaxis, anaphylactic reaction, anaphylactic shock, refractory anaphylaxis and subheadings of diagnosis, classification, epidemiology, complications and pharmacology. The level of evidence supporting an intervention was evaluated based on the availability of randomized studies, expert opinion, case studies, reviews, practice parameters and other databases (including Cochrane).
Selected publications describing anaphylaxis, clinical trials, diagnosis, mechanisms, risk factors and management were retrieved (reviews, guidelines, clinical trials, case series) and their bibliographies were also reviewed to identify relevant publications.
Data from the relevant publications were reviewed, summarized and the information synthesized.
This is a synthetic review and the data obtained from a literature review was utilized to describe current trends in the diagnosis and management of the patient with anaphylaxis with a special emphasis on newer evolving concepts of anaphylaxis endotypes and phenotypes, management of refractory anaphylaxis in the ICU setting and review of therapeutic options for the elderly patient, or the complicated patient with severe cardiorespiratory complications. Most of the recommendations come from practice parameters, case studies or expert opinions, with a dearth of randomized trials to support specific interventions.
Anaphylaxis is a rapidly progressive life-threatening disorder. The critical care physician needs to be familiar with the diagnosis, differential diagnosis, evaluation, and management of anaphylaxis. Skilled intervention in ICUs may be required for the patient with complicated, severe, or refractory anaphylaxis.
过敏反应是一种迅速进展、危及生命的综合征，表现为瘙痒、荨麻疹、血管性水肿、支气管痉挛和休克。本综述的目的是提供一种实用的、最新的方法，用于评估和管理这种疾病及其相关并发症。
使用过敏反应、过敏反应、过敏性休克、难治性过敏反应和诊断、分类、流行病学、并发症和药理学副标题的 MeSH 对 MEDLINE 进行了搜索。支持干预的证据水平是根据随机研究、专家意见、病例研究、综述、实践参数和其他数据库（包括 Cochrane）的可用性来评估的。
检索了描述过敏反应、临床试验、诊断、机制、危险因素和管理的选定出版物（综述、指南、临床试验、病例系列），并审查了它们的参考文献，以确定相关出版物。
审查、总结和综合相关出版物中的数据。
这是一篇综述，从文献综述中获得的数据用于描述过敏反应患者诊断和管理的当前趋势，特别强调过敏反应内型和表型的新概念、重症监护病房难治性过敏反应的管理以及老年患者或伴有严重心肺并发症的复杂患者的治疗选择。大多数建议来自实践参数、病例研究或专家意见，缺乏支持特定干预措施的随机试验。
过敏反应是一种迅速进展、危及生命的疾病。重症监护医师需要熟悉过敏反应的诊断、鉴别诊断、评估和管理。对于复杂、严重或难治性过敏反应的患者，可能需要在重症监护病房进行熟练的干预。
