Maddukuri Chaitanya, Kartha Navya, Conway Alexandra E, Shaker Marcus S
Cleveland Clinic Southpointe, Department of Medicine, Cleveland.
Akron Children's Hospital, Department of Pediatrics, Akron, Ohio.
Curr Opin Pediatr. 2025 Feb 1;37(1):99-106. doi: 10.1097/MOP.0000000000001397. Epub 2024 Sep 3.
To share important highlights on the management of anaphylaxis from the latest 2023 practice parameter.
The 2023 Allergy Immunology Joint Task Force on Practice Parameters (JTFPP) anaphylaxis practice parameter provides updated anaphylaxis guidance. Criteria for the diagnosis of anaphylaxis are reviewed. The parameter highlights that while anaphylaxis is not more severe in younger children, age-specific symptoms can vary. Activation of emergency medical services may not be required in patients who experience prompt resolution of symptoms following epinephrine use and caregivers are comfortable with observation. For children weighing <15 kg, the anaphylaxis parameter suggests the clinician may prescribe either the 0.1 mg or the 0.15 mg epinephrine autoinjector, with the 0.3 mg autoinjector prescribed for those weighing 25 kg or greater. In patients with heart disease, discontinuing or changing beta blockers and/or angiotensin converting enzyme inhibitors may pose a larger risk for worsened cardiovascular disease compared with risk for severe anaphylaxis with medication continuation. Furthermore, in patients with a history of perioperative anaphylaxis, shared decision-making based on diagnostic testing and clinical history is recommended prior to repeat anesthesia use. Beyond the recent parameter update, novel contemporary therapies can decrease risk of community anaphylaxis.
The 2023 JTFPP Anaphylaxis Guidelines offer up-to-date guidance for the diagnosis and management of anaphylaxis in infants, children, and adults.
分享2023年最新实践参数中关于过敏反应管理的重要要点。
2023年过敏与免疫联合实践参数工作组（JTFPP）的过敏反应实践参数提供了更新的过敏反应指南。对过敏反应的诊断标准进行了回顾。该参数强调，虽然年幼儿童的过敏反应并不更严重，但特定年龄的症状可能有所不同。对于使用肾上腺素后症状迅速缓解且护理人员对观察感到放心的患者，可能无需启动紧急医疗服务。对于体重<15 kg的儿童，过敏反应参数建议临床医生可开具0.1 mg或0.15 mg的肾上腺素自动注射器，而对于体重25 kg或更重的儿童，则开具0.3 mg的自动注射器。对于患有心脏病的患者，与继续用药导致严重过敏反应的风险相比，停用或更换β受体阻滞剂和/或血管紧张素转换酶抑制剂可能会带来更大的心血管疾病恶化风险。此外，对于有围手术期过敏反应病史的患者，在再次使用麻醉前，建议根据诊断测试和临床病史进行共同决策。除了最近的参数更新外，新型现代疗法可降低社区过敏反应的风险。
2023年JTFPP过敏反应指南为婴儿、儿童和成人过敏反应的诊断和管理提供了最新指导。
