Table 11 International research agenda for anaphylaxis ^1,2

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

Other

Studies on anaphylaxis guidelines implementation

Studies on development of anaphylaxis pathways