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Table 11 International research agenda for anaphylaxis 1,2

From: International consensus on (ICON) anaphylaxis

Management of Anaphylaxis in Healthcare and Community Settings, Risk Assessment and Reduction, and Education
Treatment in healthcare settings
Epinephrine pharmacokinetic and pharmacodynamic studies in patients with different body mass indices
Additional comprehensive studies of epinephrine absorption after different routes of administration, including auto-injectors
Additional observational investigations of the safety of a first-aid dose of epinephrine (0.3 mg intramuscularly) in patients with cardiovascular disease
Multicenter prospective randomized controlled trials to define the role of other pharmacologic interventions in anaphylaxis - examples include H1-antihistamines, H2-antihistamines, glucocorticoids, and glucagon
Management in community settings
Additional comparative studies of different epinephrine auto-injectors
  - preference to carry, preference to use, and rate of occurrence of unintentional injections and injuries
Evaluation of the role of “stock” or “unassigned” epinephrine auto-injectors in public places, eg. schools, shopping malls
Further assessment of costs of epinephrine auto-injectors and their cost-effectiveness
Further evaluation of other routes of epinephrine administration, eg. sublingual, inhaled, intranasal
Prospective validation studies of anaphylaxis emergency action plans
Comparison of different anaphylaxis emergency action plans
Assessment of effectiveness of anaphylaxis emergency action plans
Assessment of school plans for anaphylaxis
Risk assessment in anaphylaxis
Further standardization of allergens, allergen skin test protocols, and allergen challenge protocols to facilitate comparisons among centers
Further prospective studies of optimal timing of allergen skin tests after anaphylaxis to foods, venoms, drugs, and other allergens
Further development of in vitro tests such as component-resolved diagnostics and basophil activation tests to help distinguish asymptomatic sensitization from clinical risk
Development of new non-invasive tests to assess sensitization versus risk of clinical reactivity to drugs
Long-term risk reduction in anaphylaxis
Further prospective investigations of efficacy and safety of oral, sublingual, and epicutaneous immunotherapy to prevent recurrence of food-induced anaphylaxis and achieve immunologic tolerance
Further studies of the efficacy and safety of omalizumab pre-treatment and co-treatment with allergen immunotherapy
Studies of allergen immunotherapy to prevent anaphylaxis recurrences from less well-studied allergens, eg. natural rubber latex
Additional studies of immunotherapy to prevent recurrence of venom-induced anaphylaxis and immune modulation to prevent recurrence of drug-induced anaphylaxis
Additional prospective investigations of pharmacologic prophylaxis of iatrogenic anaphylaxis from radiocontrast media, biologic agents, snake anti-venom, allergen immunotherapy, etc.
Prospective investigations of the utility and cost-effectiveness of providing epinephrine auto-injectors to all patients receiving subcutaneous allergen immunotherapy with aeroallergens or venoms
Anaphylaxis education
Studies of methods to increase anaphylaxis awareness among patients, caregivers, and the public
Evaluation of educational programs for all physicians, including emergency medicine and primary care physicians
Evaluation of educational programs for other healthcare personnel, including nurses and paramedics
Evaluation of educational programs for patients at risk and caregivers
Studies of the unique needs of adolescents at risk for anaphylaxis recurrence in community settings and how best to communicate effectively with them
Evaluation of educational programs for the public
Studies of resistance to change and how to facilitate change
Studies on anaphylaxis guidelines implementation
Studies on development of anaphylaxis pathways
  1. 1Basic, clinical and applied sciences.
  2. 2This Table extends and amplifies the agendas for anaphylaxis research published independently by WAO and by EAACI.