188: Corticosteroids and Antihistamines in the Treatment of Anaphylaxis: A Systematic Review
Bibliographic record
Abstract
Despite a plethora of review and guideline literature in anaphylaxis, there is a paucity of randomized controlled trials examining the efficacy of pharmacological treatment. Consequently, there is wide variability in prescribing patterns and adherence to published guidelines. The objective of this study was determine if the use of epinephrine, corticosteroids or antihistamines affect rates of biphasic reactions in patients presenting to the emergency department (ED) with anaphylaxis. We searched Medline (1946 to September 2013) and EMBASE (1974 to September 2013) using a peer-reviewed search string to identify original, English-language studies describing pharmacological intervention for patients of all ages presenting to the ED with anaphylaxis. Exclusion criteria included single case reports, review articles, or treatment not reported. The primary outcome was the association of pharmacological treatment with biphasic reaction. Secondary outcome was the adherence to recommended guidelines for the use of pharmacotherapy in anaphylaxis. Of 1424 citiations, 1153 remained after removal of duplicates. After dual review, 35 observational studies remained. Twenty-seven studies were inlcuded in qualitative analysis, and seven studies were included in meta-analysis (pooled n=1471). Qualitative analysis revealed that current anaphylaxis guidelines are not being followed, regardless of population age or location. Corticosteroids and antihistamines are consistently prescribed more often than epinephrine. Meta-analysis revealed no significant association between of any of the medications studied and biphasic reactions. Minimal evidence supports the use of adjunctive therapy to prevent biphasic reaction for anaphylaxis. There is poor application of existing guidelines for the use of epinephrine in anaphylaxis, highlighting a role for further knowledge translation. Prospective, controlled clinical trials are needed to determine the role for adjunctive medications (corticosteroids, antihistamines) in anaphylaxis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.007 |
| Bibliometrics | 0.010 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".