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Erschienen in: Clinical and Translational Allergy 1/2017

Open Access 01.12.2017 | Brief communication

National clinical practice guidelines for food allergy and anaphylaxis: an international assessment

verfasst von: Asiyah Sheikh, Zakariya Sheikh, Graham Roberts, Antonella Muraro, Sangeeta Dhami, Aziz Sheikh

Erschienen in: Clinical and Translational Allergy | Ausgabe 1/2017

Abstract

Background

Clinical practice guidelines are important tools to promote evidence-based clinical care, but not all countries have the capacity or infrastructure to develop these in-house. The European Academy of Allergy and Clinical Immunology has recently developed guidelines for the prevention, diagnosis and management of food allergy and the management of anaphylaxis. In order to inform dissemination, adaptation and implementation plans, we sought to identify countries that have/do not have national guidelines for food allergy and anaphylaxis.

Methods

Two reviewers independently searched PubMed to identify countries with guidelines for food allergy and/or anaphylaxis from the inception of this database to December 2016. This was supplemented with a search of the Agency for Healthcare Research and Quality’s National Guideline Clearinghouse in order to identify any additional guidelines that may not have been reported in the peer-reviewed literature. Data were descriptively and narratively synthesized.

Results

Overall, 5/193 (3%) of countries had at least one guideline for food allergy or anaphylaxis. We found that one (1%) country had a national guideline for the prevention of food allergy, three (2%) countries had a guideline for the diagnosis of food allergy and three (2%) countries had a guideline for the management of food allergy. Three (2%) countries had an anaphylaxis guideline.

Conclusions

This study concludes that the overwhelming majority of countries do not have any national clinical practice guidelines for food allergy or anaphylaxis.
Hinweise
Zakariya Sheikh: joint first author

Background

The increase in the prevalence of allergic diseases seen over recent decades has resulted in food allergy and anaphylaxis emerging as important clinical conditions globally [14]. Concerns have been expressed about the clinical care patients with these conditions receive [57]. In an attempt to improve clinical care and outcomes, a number of professional and national organizations have developed clinical practice guidelines for a range of communicable and non-communicable disorders. Much of this activity has however been undertaken in high-income country settings, this reflecting the relative lack of infrastructure, capacity and financial resources available in many low- and middle-income countries (LMICs) to develop their own national guidelines. One way of bridging this gulf is to adapt and customize existing international guidelines for use in countries that do not have their own clinical guidelines [8].
The European Academy of Allergy and Clinical Immunology (EAACI) has recently produced international clinical practice guidelines on the primary prevention [9], diagnosis and management of food allergy [10] and the management of anaphylaxis [11]. In order to inform deliberations on the global dissemination, adaptation and implementation of these EAACI guidelines, we sought to identify which countries had and did not have their own clinical guidelines for food allergy and anaphylaxis.

Methods

Search strategy

We searched PubMed database using the search terms “(guideline OR practice parameter) AND (food allergy OR anaphylaxis)”. In addition, we searched the Agency for Healthcare Research and Quality’s (AHRQ) National Guideline Clearinghouse to identify any guidelines that may not have been reported in the peer-reviewed literature [12]. There was no time limit on the searches. Our searches were originally undertaken in June 2016 and were then refreshed in December 2016.

Guideline selection

Two reviewers independently screened the search results to identify documents that were formally labelled as national guidelines. From these, we selected publications that were directed towards healthcare professionals, had a clear methods section and assigned strength of evidence to recommendations. Duplicate entries were removed and, in cases where there were updates of national guidelines, we selected the most comprehensive and/or most recent version of the guideline. Discrepancies were resolved through discussion or arbitration by a third person if agreement could not be reached.

Data extraction

We independently extracted data on the body that produced these guidelines, the year of publication and the domain(s) of interest in relation to food allergy and/or anaphylaxis. Discrepancies were resolved through discussion or independent arbitration, if necessary.

Data synthesis

We undertook a descriptive analysis to identify the number and percentage of countries that had guidelines for food allergy and/or anaphylaxis. The denominator for the number of countries in the world (n = 193) was taken from the list of the United Nations (UN) Member States [13]. We then divided the food allergy guidelines into sub-domains focusing on aspects of prevention, diagnosis and management.

Results

Our searches of PubMed identified a total of 855 hits from which we selected 60 papers for detailed analysis. Of these, seven satisfied our inclusion criteria. Searching the AHRQ website failed to identify any additional guidelines. We in addition found 11 pan-national guidelines for food allergy prevention (n = 5) [9, 1417], diagnosis (n = 2) [10, 14] and management (n = 3) [10, 14, 18], and anaphylaxis (n = 3) [11, 19, 20]. “Appendix” details documents that appeared not to meet our inclusion criteria, but which we were unable to fully assess.

Overall findings

We found that 5/193 (3%) countries had at least one guideline on food allergy or anaphylaxis (Table 1).
Table 1
Countries with one or more clinical guidelines for food allergy and/or anaphylaxis
Countries
Food allergy
Anaphylaxis (Y/N)
Prevention (Y/N)
Diagnosis (Y/N)
Management (Y/N)
 
Germany
N
Y
Y
N
Singapore
N
N
Y
N
Spain
N
N
N
Y
UK
N
Y
N
Y
USA
Y
Y
Y
Y
Total
1
3
3
3

Food allergy

Four (2%) countries had guidelines on some aspect of food allergy (see Table 1). These comprised of one (1%) covering aspects of food allergy prevention, three (2%) dealing with diagnosis, and three (2%) dealing with food allergy management (Table 2).
Table 2
National guidelines for food allergy
Country
Source
Published
URL
Prevention
USA
American Academy of Allergy, Asthma and Immunology (AAAAI); the American College of Allergy, Asthma and Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology (JCAAI)
2014
Diagnosis
Germany
German Society of Allergology and Clinical Immunology (DGAKI), the Physicians’ Association of German Allergologists (ADA) and the Society of Pediatric Allergology (GPA) together with the Swiss Society of Allergology. German Society for Allergology and Clinical Immunology
2011
UK
National Institute for Health and Care Excellence (NICE)
2016
USA
National Institute of Allergy and Infectious Diseases
American Academy of Allergy, Asthma and Immunology (AAAAI); the American College of Allergy, Asthma and Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology (JCAAI)
2010, 2014
Management
Germany
German Society of Allergology and Clinical Immunology (DGAKI); Medical Association of German Allergologists (ADA); German Society of Pediatric Allergology
2009
Singapore
Academy of Medicine, Singapore (AMS) and the Ministry of Health
2010
USA
National Institute of Allergy and Infectious Diseases
American Academy of Allergy, Asthma and Immunology (AAAAI); the American College of Allergy, Asthma and Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology (JCAAI)
2010

Anaphylaxis

Three (2%) of countries has guidelines dealing with anaphylaxis (see Table 3).
Table 3
National guidelines for the management of anaphylaxis
Country
Source
Published
URL
Spain
Sociedad Espanola de Alergologia e Inmunologia Clinica
2011
UK
National Institute for Health and Care Excellence
2011
US
Joint task force on practice parameters, representing the American Academy of Allergy, Asthma and Immunology (AAAAI); the American College of Allergy, Asthma and Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology
2015

Discussion

Summary of principal findings

This analysis of the international literature has found that only a minority of countries have any formally produced clinical practice guidelines for food allergy and anaphylaxis with the major gaps being in African and Asian countries. This is a concern considering that food allergy and anaphylaxis now affect people globally and furthermore they are associated with significant morbidity and, in some cases, mortality [21, 22].

Strengths and limitations

The key strengths of this study are that we formally searched the principal biomedical database, namely PubMed using established systematic search techniques and that these searches were from the inception of this database and were not restricted by language. Furthermore, we cross-checked the results with AHRQ’s National Guideline Clearinghouse, which is the foremost repository of clinical guidelines.
The main limitation is that we may have missed some guidelines that were either not formally published in the peer-reviewed literature and/or were not available in English. We may also have missed guidelines that are in development.

Interpretation in the light of previous published research

This is, as far as we are aware, the first truly international overview of guidelines available for both food allergy and anaphylaxis. It builds on a recent comparison of food allergy guidelines [23] and our earlier study focused on anaphylaxis, both of which found a more limited number of guidelines and considerable variation in the recommendations contained in these guidelines [24]. This work subsequently contributed to the creation of an International Consensus statement on anaphylaxis [25].

Conclusions

The findings of this study point to considerable gaps in the availability of national guidelines for food allergy and anaphylaxis. EAACI and other international guideline bodies should consider working with the countries that currently have no national guidelines to produce clinical practice guidelines on food allergy and anaphylaxis that are language specific and tailored to their local needs. Furthermore we suggest compiling an online database on the EAACI website which logs adapted versions of the guideline and also proactively sending details of these adapted guidelines for listing on the AHRQ’s National Guideline Clearinghouse: https://​www.​guideline.​gov/​.

Competing interests

Graham Roberts, Antonella Muraro, Sangeeta Dhami and Aziz Sheikh were involved in the production of the EAACI Anaphylaxis Guidelines. The authors declare no other conflicts of interests in relation to this work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.
Anhänge

Appendix

See Table 4.
Table 4
National guidelines that we were unable to formally assess
Name
Country
Year
Reason for exclusion
Practice guidelines 2005: management of anaphylaxis
Japan
2006
In Japanese
Allergies in the 1st life year. The allergy prevention guideline 2004 of the allergy prevention action alliance (abap)
German
2005
In German
Anaphylaxis guideline—its incentives and pre-hospital care
Japan
2016
In Japanese
Japanese guideline for food allergy 2012 specific type of food allergy
Japan
2012
In Japanese
Japanese pediatric guideline for food allergy 2012]
Japan
2012
In Japanese
JSA anaphylaxis guideline—importance of basic management and prevention
Japan
2015
In Japanese
Practice guidelines for food allergy
Japan
2012
In Japanese
New approach and recommendation in JAGL2007 (Japanese guideline for the diagnosis and treatment of allergic diseases 2007)
Japan
2009
In Japanese
Evidence based recommendations for the diagnosis and management of cow’s milk allergy in Chinese infants
China
2013
In Chinese
Literatur
1.
Zurück zum Zitat Nwaru BI, Hickstein L, Panesar SS, Muraro A, Werfel T, Cardona V, et al. The epidemiology of food allergy in Europe: a systematic review and meta-analysis. Allergy. 2014;69(1):62–75.CrossRefPubMed Nwaru BI, Hickstein L, Panesar SS, Muraro A, Werfel T, Cardona V, et al. The epidemiology of food allergy in Europe: a systematic review and meta-analysis. Allergy. 2014;69(1):62–75.CrossRefPubMed
2.
Zurück zum Zitat Panesar SS, Javad S, de Silva D, Nwaru BI, Hickstein L, Muraro A, et al. The epidemiology of anaphylaxis in Europe: a systematic review. Allergy. 2013;68(11):1353–61.CrossRefPubMed Panesar SS, Javad S, de Silva D, Nwaru BI, Hickstein L, Muraro A, et al. The epidemiology of anaphylaxis in Europe: a systematic review. Allergy. 2013;68(11):1353–61.CrossRefPubMed
3.
Zurück zum Zitat Lieberman P, Camargo CA Jr, Bohlke K, Jick H, Miller RL, Sheikh A, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol. 2006;97(5):596–602.CrossRefPubMed Lieberman P, Camargo CA Jr, Bohlke K, Jick H, Miller RL, Sheikh A, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol. 2006;97(5):596–602.CrossRefPubMed
4.
Zurück zum Zitat Koplin JJ, Mills EN, Allen KJ. Epidemiology of food allergy and food-induced anaphylaxis: Is there really a Western world epidemic? Curr Opin Allergy Clin Immunol. 2015;15(5):409–16.CrossRefPubMed Koplin JJ, Mills EN, Allen KJ. Epidemiology of food allergy and food-induced anaphylaxis: Is there really a Western world epidemic? Curr Opin Allergy Clin Immunol. 2015;15(5):409–16.CrossRefPubMed
5.
Zurück zum Zitat Song TT, Worm M, Lieberman P. Anaphylaxis treatment: current barriers to adrenaline auto-injector use. Allergy. 2014;69(8):983–91.CrossRefPubMed Song TT, Worm M, Lieberman P. Anaphylaxis treatment: current barriers to adrenaline auto-injector use. Allergy. 2014;69(8):983–91.CrossRefPubMed
6.
Zurück zum Zitat Sheikh A, Dhami S, Regent L, Austin M, Sheikh A. Anaphylaxis in the community: a questionnaire survey of members of the UK Anaphylaxis Campaign. JRSM Open. 2015;6(7):2054270415593443.CrossRefPubMedPubMedCentral Sheikh A, Dhami S, Regent L, Austin M, Sheikh A. Anaphylaxis in the community: a questionnaire survey of members of the UK Anaphylaxis Campaign. JRSM Open. 2015;6(7):2054270415593443.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Muraro A, Halken S, Arshad SH, Beyer K, Dubois AE, Du Toit G, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy. 2014;69(5):590–601. doi:10.1111/all.12398.CrossRefPubMed Muraro A, Halken S, Arshad SH, Beyer K, Dubois AE, Du Toit G, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy. 2014;69(5):590–601. doi:10.​1111/​all.​12398.CrossRefPubMed
10.
Zurück zum Zitat Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69(8):1008–25. doi:10.1111/all.12429.CrossRefPubMed Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69(8):1008–25. doi:10.​1111/​all.​12429.CrossRefPubMed
11.
Zurück zum Zitat Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026–45.CrossRefPubMed Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026–45.CrossRefPubMed
14.
Zurück zum Zitat Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, et al. World Allergy Organization (WAO) Special Committee on Food Allergy. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines. Pediatr Allergy Immunol. 2010;21(Suppl 21):1–125. doi:10.1111/j.1399-3038.2010.01068.x.PubMed Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, et al. World Allergy Organization (WAO) Special Committee on Food Allergy. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines. Pediatr Allergy Immunol. 2010;21(Suppl 21):1–125. doi:10.​1111/​j.​1399-3038.​2010.​01068.​x.PubMed
15.
Zurück zum Zitat Yepes-Nuñez JJ, Fiocchi A, Pawankar R, Cuello-Garcia CA, Zhang Y, Morgano GP, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): vitamin D. World Allergy Organ J. 2016;17(9):17. doi:10.1186/s40413-016-0108-1.CrossRef Yepes-Nuñez JJ, Fiocchi A, Pawankar R, Cuello-Garcia CA, Zhang Y, Morgano GP, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): vitamin D. World Allergy Organ J. 2016;17(9):17. doi:10.​1186/​s40413-016-0108-1.CrossRef
17.
Zurück zum Zitat Cuello-Garcia CA, Fiocchi A, Pawankar R, Yepes-Nuñez JJ, Morgano GP, Zhang Y, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): prebiotics. World Allergy Organ J. 2016;1(9):10. doi:10.1186/s40413-016-0102-7.CrossRef Cuello-Garcia CA, Fiocchi A, Pawankar R, Yepes-Nuñez JJ, Morgano GP, Zhang Y, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): prebiotics. World Allergy Organ J. 2016;1(9):10. doi:10.​1186/​s40413-016-0102-7.CrossRef
19.
Zurück zum Zitat Simons FE, Ardusso LR, Dimov V, Ebisawa M, El-Gamal YM, Lockey RF, et al. World Allergy Organization Anaphylaxis Guidelines: 2013 update of the evidence base. Int Arch Allergy Immunol. 2013;162(3):193–204. doi:10.1159/000354543.CrossRefPubMed Simons FE, Ardusso LR, Dimov V, Ebisawa M, El-Gamal YM, Lockey RF, et al. World Allergy Organization Anaphylaxis Guidelines: 2013 update of the evidence base. Int Arch Allergy Immunol. 2013;162(3):193–204. doi:10.​1159/​000354543.CrossRefPubMed
20.
Zurück zum Zitat Simons FER, Ardusso LRF, Bilò BM, Dimov V, Ebisawa M, El-Gamal YM, et al. 2012 Update: World Allergy Organization Guidelines for the assessment and management of anaphylaxis. Curr Opin Allergy Clin Immunol. 2012;12(4):389–99. doi:10.1097/ACI.0b013e328355b7e4.CrossRefPubMed Simons FER, Ardusso LRF, Bilò BM, Dimov V, Ebisawa M, El-Gamal YM, et al. 2012 Update: World Allergy Organization Guidelines for the assessment and management of anaphylaxis. Curr Opin Allergy Clin Immunol. 2012;12(4):389–99. doi:10.​1097/​ACI.​0b013e328355b7e4​.CrossRefPubMed
21.
Zurück zum Zitat Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30(8):1144–50.CrossRefPubMed Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30(8):1144–50.CrossRefPubMed
22.
Zurück zum Zitat Bock SA, Muñoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol. 2007;119(4):1016–8.CrossRefPubMed Bock SA, Muñoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol. 2007;119(4):1016–8.CrossRefPubMed
24.
Zurück zum Zitat Alrasbi M, Sheikh A. Comparison of international guidelines for the emergency medical management of anaphylaxis. Allergy. 2007;62(8):838–41.CrossRefPubMed Alrasbi M, Sheikh A. Comparison of international guidelines for the emergency medical management of anaphylaxis. Allergy. 2007;62(8):838–41.CrossRefPubMed
25.
Zurück zum Zitat Simons FE, Ardusso LR, Bilò MB, Cardona V, Ebisawa M, El-Gamal YM, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7(1):9.CrossRefPubMedPubMedCentral Simons FE, Ardusso LR, Bilò MB, Cardona V, Ebisawa M, El-Gamal YM, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7(1):9.CrossRefPubMedPubMedCentral
Metadaten
Titel
National clinical practice guidelines for food allergy and anaphylaxis: an international assessment
verfasst von
Asiyah Sheikh
Zakariya Sheikh
Graham Roberts
Antonella Muraro
Sangeeta Dhami
Aziz Sheikh
Publikationsdatum
01.12.2017
Verlag
BioMed Central
Erschienen in
Clinical and Translational Allergy / Ausgabe 1/2017
Elektronische ISSN: 2045-7022
DOI
https://doi.org/10.1186/s13601-017-0161-z

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