National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
J Allergy Clin Immunol. 2021 Nov;148(5):1307-1315. doi: 10.1016/j.jaci.2021.03.042. Epub 2021 Apr 20.
Regulatory bodies recommend that all patients at risk of anaphylaxis be prescribed 2 epinephrine autoinjectors, which they should carry at all times. This is in contrast to some guidelines. The proportion of anaphylaxis reactions that are treated with multiple doses of epinephrine has not been systematically evaluated.
Our aim was to undertake a systematic review and meta-analysis of published studies reporting epinephrine treatment for anaphylaxis in which data relating to the number of doses administered were available.
We searched the Medline, Embase, and Cochrane databases for relevant studies reporting at least 10 anaphylaxis events (due to food or venom) from 1946 until January 2020. Data were extracted in duplicate for the meta-analysis, and the risk of bias was assessed. The study was registered under the PROSPERO identifier CRD42017069109.
A total of 86 studies (36,557 anaphylaxis events) met the inclusion criteria (20 of the studies [23%] were prospective studies; 64 [74%] reported reactions in the community, and 22 [26%] included food challenge data). Risk of bias was assessed as low in 50 studies. Overall, 7.7% of anaphylaxis events from any cause (95% CI = 6.4-9.1) were treated with multiple doses of epinephrine. When only epinephrine-treated reactions for which subsequent doses were administered by a health care professional were considered, 11.1% of food-induced reactions (95% CI = 9.4-13.2) and 17.1% of venom-induced reactions (95% CI = 11.3-25.0) were treated with more than 1 epinephrine dose. Heterogeneity was moderate to high in the meta-analyses, but at sensitivity analysis this estimate was not affected by study design or anaphylaxis definition.
Around 1 in 10 anaphylaxis reactions are treated with more than 1 dose of epinephrine.
监管机构建议所有有发生过敏反应风险的患者都应配备 2 支肾上腺素自动注射器，并随时携带。这与一些指南的建议相反。尚未系统评估使用多次肾上腺素剂量治疗过敏反应的比例。
我们旨在对发表的研究进行系统评价和荟萃分析，这些研究报告了可获得肾上腺素给药剂量数据的过敏反应治疗情况。
我们检索了 Medline、Embase 和 Cochrane 数据库，以查找自 1946 年至 2020 年 1 月至少报告了 10 例（因食物或毒液引起）过敏反应事件的相关研究。对荟萃分析进行了重复数据提取，并评估了偏倚风险。该研究在 PROSPERO 标识符 CRD42017069109 下进行了注册。
共有 86 项研究（36557 例过敏反应事件）符合纳入标准（20 项研究[23%]为前瞻性研究；64 项[74%]报告了社区中的反应，22 项[26%]包括食物挑战数据）。50 项研究的偏倚风险评估为低。总体而言，任何原因引起的过敏反应事件中有 7.7%（95% CI=6.4-9.1）使用了多次肾上腺素剂量进行治疗。当仅考虑由医疗保健专业人员给予后续剂量的接受肾上腺素治疗的反应时，11.1%的食物诱导反应（95% CI=9.4-13.2）和 17.1%的毒液诱导反应（95% CI=11.3-25.0）使用了超过 1 剂肾上腺素。荟萃分析中的异质性为中度至高度，但在敏感性分析中，该估计值不受研究设计或过敏反应定义的影响。
约 10%的过敏反应需要使用超过 1 剂肾上腺素进行治疗。
