Bibliographic record
Abstract
Epinephrine is the first line treatment for anaphylaxis, which is a serious allergic reaction that can rapidly progress and may cause death. As a nonselective adrenergic agonist, epinephrine rapidly works to increase vasoconstriction and peripheral vascular resistance, increase cardiac output, reverse bronchoconstriction and mucosal edema, and inhibit the release of mediators of inflammation from mast cells and basophils. The anaphylaxis guidelines developed by the Joint Task Force on Practice Parameters (JTFPP) in 2020, the World Allergy Organization (WAO) in 2020, and the European Academy of Allergy and Clinical Immunology (EAACI) in 2021 advise clinicians to prescribe self-injectable epinephrine to individuals at risk of anaphylaxis and educate them on when and how to administer it. In 2023, the JTFPP updated its anaphylaxis practice parameter to address seven key topic areas, including multiple questions and recommendations related to epinephrine prescription and use. The practice parameter authors graded each recommendation as conditional or strong, based in part on the certainty of the supporting evidence. We provide an overview of key recommendations and discuss their applications in the Canadian context. It is important to note that in Canada, EpiPen® autoinjectors are currently the sole epinephrine delivery devices available with premeasured doses of epinephrine for the emergency treatment of allergic reactions. These autoinjectors should be administered intramuscularly into the anterolateral thigh. Additional epinephrine devices may become available in the future, including the first epinephrine nasal spray (neffy®). There is a wider variety of epinephrine devices available in the United States, including multiple brands of epinephrine autoinjectors (Adrenaclick®, Auvi-Q®, EpiPen®/EpiPen® Jr., and generic versions). Additionally, there is one brand of epinephrine prefilled syringe (Symjepi™) and one brand of nasal spray (neffy®). Although the anaphylaxis practice parameter update was published before the U.S. Food and Drug Administration had approved neffy®, we believe its recommendations for epinephrine prescription and use may be appropriately extended to include epinephrine nasal spray where it is available.
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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 | 0.008 | 0.091 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.008 | 0.008 |
| Insufficient payload (model declined to judge) | 0.095 | 0.057 |
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".