2026-04-14T02:38:19Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/118592025-10-24T10:30:47Zcom_2072_378070com_2072_378040col_2072_378092

2025-10-24T10:30:47Z urn:hdl:11351/11859 Management of Refractory Anaphylaxis: An Overview of Current Guidelines Pouessel, Guillaume Dribin, Tim Tacquard, Charles Worm, Margitta Tanno, Luciana Cardona, Victoria Anafilaxi - Tractament Medicaments cardiovasculars - Ús terapèutic Adrenalina - Ús terapèutic DISEASES::Immune System Diseases::Hypersensitivity::Hypersensitivity, Immediate::Anaphylaxis Other subheadings::Other subheadings::/therapy CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Cardiovascular Agents::Vasoconstrictor Agents CHEMICALS AND DRUGS::Organic Chemicals::Alcohols::Amino Alcohols::Ethanolamines::Epinephrine ENFERMEDADES::enfermedades del sistema inmune::hipersensibilidad::hipersensibilidad inmediata::anafilaxia Otros calificadores::Otros calificadores::/terapia COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::fármacos cardiovasculares::vasoconstrictores COMPUESTOS QUÍMICOS Y DROGAS::compuestos orgánicos::alcoholes::alcoholes amino::etanolaminas::epinefrina Adrenaline; Anaphylaxis; Vasopressors Adrenalina; Anafilaxi; Vasopressors Adrenalina; Anafilaxia; Vasopresores In this review, we compare different refractory anaphylaxis (RA) management guidelines focusing on cardiovascular involvement and best practice recommendations, discuss postulated pathogenic mechanisms underlining RA and highlight knowledge gaps and research priorities. There is a paucity of data supporting existing management guidelines. Therapeutic recommendations include the need for the timely administration of appropriate doses of aggressive fluid resuscitation and intravenous (IV) adrenaline in RA. The preferred second-line vasopressor (noradrenaline, vasopressin, metaraminol and dopamine) is unknown. Most guidelines recommend IV glucagon for patients on beta-blockers, despite a lack of evidence. The use of methylene blue or extracorporeal life support (ECLS) is also suggested as rescue therapy. Despite recent advances in understanding the pathogenesis of anaphylaxis, the factors that lead to a lack of response to the initial adrenaline and thus RA are unclear. Genetic factors, such as deficiency in platelet activating factor-acetyl hydrolase or hereditary alpha-tryptasaemia, mastocytosis may modulate reaction severity or response to treatment. Further research into the underlying pathophysiology of RA may help define potential new therapeutic approaches and reduce the morbidity and mortality of anaphylaxis. This work has no funding. P.J.T. is supported by the UK Medical Research Council (Grant Ref: MR/W018616/1), and through the NHR Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising. T.E.D. is supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health, under Award Number UL1TR001425. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. 2025-10-24T10:30:47Z 2025-10-24T10:30:47Z 2024-08-22T10:26:19Z 2024-08-22T10:26:19Z 2024-07 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://hdl.handle.net/11351/11859 Clinical & Experimental Allergy;54(7) https://doi.org/10.1111/cea.14514 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess Wiley Scientia