Corticosteroids in management of anaphylaxis; a systematic review of evidence
| Autor: | Suranjith L. Seneviratne, Chiranthi K. Liyanage, Priyadarshani Galappatthy |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Allergy 040301 veterinary sciences medicine.drug_class Risk Assessment 0403 veterinary science 03 medical and health sciences 0302 clinical medicine Adrenal Cortex Hormones Risk Factors medicine Animals Humans Immunology and Allergy Intensive care medicine Anaphylaxis Evidence-Based Medicine business.industry 030208 emergency & critical care medicine 04 agricultural and veterinary sciences Emergency department Length of Stay medicine.disease Clinical trial Treatment Outcome Epinephrine Prednisolone Corticosteroid Observational study Patient Safety Emergency Service Hospital business medicine.drug |
| Zdroj: | European Annals of Allergy and Clinical Immunology. 49:196 |
| ISSN: | 1764-1489 |
| Popis: | Summary As anaphylaxis is a medical emergency, there are no randomized controlled clinical trials on its emergency management. Therefore, current guidelines are mostly based on data from observational studies, animal and laboratory studies. Although epinephrine is the mainstay of recommended treatment, corticosteroids are also frequently used. This review evaluates the evidence on the use of corticosteroids in emergency management of anaphylaxis from published human and animal or laboratories studies. Thirty original research papers were found with 22 human studies and eight animal or laboratory studies. The average rate of corticosteroid use in emergency treatment was 67.99% (range 48% to 100%). Corticosteroids appear to reduce the length of hospital stay, but did not reduce revisits to the emergency department. There was no consensus on whether corticosteroids reduce biphasic anaphylactic reactions. None of the human studies had sufficient data to compare the response to treatment in different treatment groups (i.e. corticosteroids, epinephrine, antihistamines). Animal studies demonstrated that corticosteroids act through multiple mechanisms. These modulate gene expression, with effects becoming evident 4 to 24 hours after administration. A much quicker response has been detected within 5 to 30 minutes, through blockade of signal activation of glucocorticoid receptors independent of their genomic effects. Therefore, we conclude that there is no compelling evidence to support or oppose the use of corticosteroid in emergency treatment of anaphylaxis. However, based on the available data, it appears to be beneficial and there was no evidence of adverse outcomes related to the use of corticosteroids in emergency treatment of anaphylaxis. |
| Databáze: | OpenAIRE |
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