There is plenty of allergy research taking place in our region. This research seeks to enhance the clinical care of patients and families locally, and beyond.
Allergy services in the North East of England have a well-established research network as part of the Great North Children’s Hospital Research Community (GNCH-RC). They work closely with Newcastle University and other universities in the UK and provide supervision of Masters’, and other research students, who are undertaking allergy projects.
If you have an interest in participating in this work – and contributing to innovative ideas and solutions that will make a difference to anaphylaxis care – please contact Dr Louise Michaelis and further details of research projects can be found here.
Recent Regional Clinical Trials
There have been two clinical trials undertaken in the North East with regards to Anaphylaxis and worthy of a mention. The SNIFFLE 2 Clinical Trial, 2014/2015 flu season showed that “the LAIV did not cause any systemic allergic reactions in young people with egg allergy”. “LAIV was well tolerated in young people with a diagnosis of asthma or recurrent wheeze, provided that lower respiratory symptoms are well controlled”. Subsequently, the SNIFFLE 4 Clinical Trial, 2019/2020 flu season showed that ‘‘children with asthma on inhaled corticosteroids may safely be given LAIV, irrespective of the dose prescribed,’’ although LAIV continues to be not recommended in those with an acute exacerbation of asthma symptoms in the previous 72 hours.
Other Useful Resources
This section contains some important ‘up to date’ reading that you need to be aware of, along with other recent interesting commentaries and reviews.
Evidence-based medicine (EBM) is thought to be the best approach for teaching and practising clinical medicine by incorporating “the best available external clinical evidence from a systematic search” of all the literature. For Anaphylaxis, the best available evidence about treatment, randomised controlled trials (RCTs) and a systematic review (SR)/meta-analysis for Anaphylaxis are considered the “gold standard”. We bring you the recent EAACI International Taskforces where the literature has been screened, reviewed, analysed and debated by GRADE Evidence.
- Debra de Silva, Chris Singh, Antonella Muraro, Margitta Worm, Cherry Alviani, Victoria Cardona, Audrey DunnGalvin, Lene Heise Garvey, Carmen Riggioni, Elizabeth Angier, Stefania Arasi, Abdelouahab Bellou, Kirsten Beyer, Diola Bijlhout, M Beatrice Bilo, Knut Brockow, Montserrat Fernandez‐Rivas, Susanne Halken, Britt Jensen, Ekaterina Khaleva, Louise J Michaelis, Hanneke Oude Elberink, Lynne Regent, Angel Sanchez, Berber Vlieg‐Boerstra, Graham Roberts, Diagnosing, managing and preventing anaphylaxis: systematic review. European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group. 2020/9/2. Allergy https://onlinelibrary.wiley.com/doi/abs/10.1111/all.14580
This year we have seen adrenaline autoinjectors fail and be subsequently removed from the market. Public data on the pharmacokinetics–pharmacodynamics of adrenaline administered via an auto-injector is hard to find. The sparse literature found shows variation in the plasma concentrations of adrenaline administered through an auto-injector, alongside variations in the auto-injector needle length. Thus, as professionals we know delivering an effective dose during an anaphylaxis remains a challenge for both our patients and their families. Collaboration between professionals, industry and scientists experts is vital to improve outcomes of anaphylaxis.
- Moss, J., Jani, Y., Edwards, B., Tomli, S. and Rashed, A.N., 2020. Pharmacokinetic and pharmacodynamic evidence of adrenaline administered via auto‐injector for anaphylactic reactions: A review of literature.British Journal of Clinical Pharmacology.
Worldwide, guidelines recommend the use of adrenaline autoinjectors (AAIs) first line for self-medication in patients who experience a severe allergic reaction. You hear it all the time – ALWAYS CARRY TWO, however this recommendation has led to large debates across Europe and beyond. Is it cost effective, is one device sufficient, what are the pros and cons? In this study, the authors aimed to examine the adherence to such guidelines and analysed prescription behaviour of allergy experts regarding the number of AAIs prescribed for a given patient.
- Kraft M, Dölle-Bierke S, Turner PJ, Muraro A, Fernández-Rivas M, Grabenhenrich L, Worm M et al., 2020, EAACI Task force Clinical epidemiology of anaphylaxis: experts’ perspective on the use of adrenaline autoinjectors in Europe, Clinical and Translational Allergy, Vol: 10, ISSN: 2045-7022. http://dx.doi.org/10.1186/s13601-020-00317-y
There is well established evidence of a global increase in the rates of anaphylaxis, with no evidence of a parallel increase in fatality rates (0.5% to 1%). The authors identify ‘potentially modifiable risk factors that can be used to inform clinical practice: (i) prevention of delayed epinephrine administration, (ii) correct posturing during anaphylaxis, (iii) alerts to populations at risk, and (iv) use of venom immunotherapy in individuals at risk of insect-related anaphylaxis’.
- Turner P, Campbell DE, Motosue MS, Campbell RL et al., 2020, Global trends in anaphylaxis epidemiology and clinical implications, Journal of Allergy and Clinical Immunology: In Practice, Vol: 8, Pages: 1169-1176, ISSN: 2213-2201. http://dx.doi.org/10.1016/j.jaip.2019.11.027
There have been two clinical trials undertaken in the North East with regards to Anaphylaxis and worthy of a mention.The SNIFFLE 2 Clinical Trial, 2014/2015 flu season showed that “the LAIV did not cause any systemic allergic reactions in young people with egg allergy”. “LAIV was well tolerated in young people with a diagnosis of asthma or recurrent wheeze, provided that lower respiratory symptoms are well controlled”. Subsequently, the SNIFFLE 4 Clinical Trial, 2019/2020 flu season showed that ‘‘children with asthma on inhaled corticosteroids may safely be given LAIV, irrespective of the dose prescribed,’’ although LAIV continues to be not recommended in those with an acute exacerbation of asthma symptoms in the previous 72 hours.
SNIFFLE 2: ClinicalTrials.gov (NCT02111512): EudraCT (2014-001537-92 (here)
- Turner PJ, Southern J, Andrews NJ, Miller E, Lajeunesse ME, on behalf of SNIFFLE 2 Investigators, Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study. 2015/11/05. British Medical Journal; 352:h6291/ doi; 10.136/bmj.h6291.
SNIFFLE 4: ClinicalTrials.gov (NCT02866942): EudraCT (2016-002352-24) (here)
- Turner PJ, Fleming L, Saglani S, Southern J, Andrews NJ, Milelr E on behalf of SNIFFLE 4 Investigators, Safety of live attenuated influenza vaccine (LAIV) in chidlren with moderate to severe asthma. 2020; 145:1157-64.
Guidelines and Taskforces
Shaker MS et al. Anaphylaxis – a 2020 practice parameter update, systematic review, and grading of Recommendations, Assessment, development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020 Apr;145(4):1082-1123.doi: 10.1016/j.jaci.2020.01.017 Epub 2020 Jan 28.
Muraro, A, Roberts, G, Worm, M, Bilò, MB, Brockow, K, Fernández Rivas, M, Santos, AF, Zolkipli, ZQ, Bellou, A Beyer, K, Bindslev‐Jensen, C, Cardona, V, Clark, AT, Demoly, P, Dubois, AEJ, DunnGalvin, A, Eigenmann, P, Halken, S, Harada, L, Lack, G, Jutel, M, Niggemann, B, Ruёff, F, Timmermans, F, Vlieg–Boerstra, BJ, Werfel, T, Dhami, S, Panesar, S, Akdis, CA, Sheikh, A on behalf of the EAACI Food Allergy and Anaphylaxis Guidelines Group. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology.
Allergy 2014; 69: 1026– 1045. https://onlinelibrary.wiley.com/doi/full/10.1111/all.12437
2012 Update: World Allergy Organisation Guidelines for the assessment and management of anaphylaxis.
BSACI Emergency anaphylactic treatment:
NICE Guideline and quality standard for Primary care: Resuscitation Council UK: Guidelines of emergency management of anaphylaxis. 2008.
NICE Guideline: Anaphylaxis: assessment and referral after emergency treatment. Clinical guidelines CG134.
Published December 2011. Last updated 24 August 2020. https://www.nice.org.uk/guidance/CG134