Joint task force releases anaphylaxis, atopic dermatitis treatment parameters
Click Here to Manage Email Alerts
Key takeaways:
- Based on response, patients may not need to visit the ED after using an epinephrine autoinjector.
- The authors suggested against the use of systemic corticosteroids for treating atopic dermatitis.
Two new practice parameters from a joint task force published in Annals of Allergy, Asthma & Immunology provide evidence-based recommendations for the diagnosis and management of anaphylaxis and atopic dermatitis.
“Both anaphylaxis and atopic dermatitis are allergic conditions that affect millions of people in the United States and around the world,” Jay A. Lieberman, MD, FACAAI, co-chair of the Allergy Immunology Joint Task Force for Practice Parameters (JTFPP), said in a press release.
The Joint Task Force is a partnership between the American College of Allergy, Asthma & Immunology and the American Academy of Allergy, Asthma & Immunology.
“We regularly update our practice parameters to make sure allergists and other health care practitioners are aware of best practices when diagnosing and managing these disorders,” Lieberman, who also is a member of the Healio Allergy/Asthma Peer Perspective Board, continued. “When physicians and their staffs are aware of updated guidance, it means patients are getting the best, most appropriate care.”
Anaphylaxis parameter
The practice parameter for anaphylaxis supports optimal contextual care across contemporary practice settings, lead author and allergist David B.K. Golden, MDCM, said in the press release.
“With important new guidance related to diagnostic evaluation, anaphylaxis in infants and in community settings, epinephrine treatment, mast cell conditions, beta-blockers and ACE [angiotensin-converting enzyme] inhibitors, and peri-operative anaphylaxis, these guidelines translate recent advances in the understanding of severe allergic reactions to help all health care professionals provide individualized care to each patient at the right time, in the right place, every time,” Golden said.
The practice parameter on anaphylaxis focuses on areas where new evidence has emerged, according to the authors, and where recommendations have evolved.
For example, recommendations about whether patients need to go to the ED if they use epinephrine for anaphylaxis have been updated. If patients experience prompt, complete and durable response to treatment with an epinephrine autoinjector (EAI) and have access to additional EAIs, according to the parameter, they may not need to call emergency services (EMS).
Severe anaphylaxis, symptoms that do not resolve promptly, completely or nearly completely, or symptoms that return or worsen would warrant EMS activation, the parameter continues.
The parameter also includes recommendations on how and where EAIs should be stored and who should store them, along with updates on the diagnosis of anaphylaxis, as the World Allergy Organization, Brighton and Delphi consensus groups strive for more universally accepted definitions and criteria for anaphylactic reactions.
Further, the parameter includes updates on how to recognize and treat anaphylaxis in infants. There are no age-specific criteria for diagnosing anaphylaxis, the authors wrote, making diagnosis in infants and toddlers challenging. As a result, the authors called for the use of current National Institute of Allergy and Infectious Diseases, Food Allergy & Anaphylaxis Network or World Allergy Organization criteria in establishing these diagnoses.
Additional updates include how to evaluate and treat anaphylaxis in relation to a surgery as well as nuances in the use of beta-blockers and ACE inhibitors in patients at risk for anaphylaxis.
Atopic dermatitis parameter
The parameter for atopic dermatitis represents an advance in trustworthy allergy guidelines, allergist Derek Chu, MD, PhD, assistant professor in the department of medicine at McMaster University, said in the press release.
“It is distinguished from other guidelines through systematic reviews of the evidence with multidisciplinary panelist engagement, adherence to GRADE [Grading of Recommendations, Assessment, Development, and Evaluations] — a rigorous guideline development process — as well as the involvement of the patient and caregiver voice from start to finish,” Chu said.
Chu called the clear translation of evidence to clinically actionable and contextual recommendations, as well as novel approaches to facilitate knowledge translation, paramount.
“The guidelines emphasize, in addition to standards of trustworthiness, the third principle of evidence-based medicine: that evidence alone is never enough, that patient values and preferences are crucial to arriving at optimal recommendations,” Chu said. “The new recommendations also reflect the evolution of diversity, equity and inclusion in approaching diagnosis and management of this condition.”
The parameter recommends topical corticosteroids or topical calcineurin inhibitors for patients who have uncontrolled AD despite the use of moisturizers and for patients with a relapsing course, highlighting the safety of topical calcineurin inhibitors with typical once- or twice-daily usage.
The authors also advised consideration of once-daily dosing of topical medications.
Dupilumab (Dupixent; Sanofi, Regeneron) was recommended for patients aged 6 months or older with moderate to severe refractory AD as well as for patients who are intolerant of or unable to use mid-potency topical treatment. Tralokinumab (Adbry, LEO Pharma) was recommended for similar patients aged 12 years and older.
The parameter suggested that patients with AD do not engage in elimination diets or use topical antibiotics for AD alone with no infection, but it did suggest the use of crisaborole 2% ointment (Eucrisa, Pfizer) for mild to moderate AD.
Also, the parameter suggested that patients with moderate to severe AD but not mild AD use bleach baths as an additive therapy. It suggested consideration of allergen immunotherapy for moderate to severe AD as well.
After careful consideration of risks and benefits, the parameter continued, adults and adolescents with refractory moderate to severe AD or who are otherwise intolerant of or unable to use mid- to high-potency topical treatment and biologics may use oral Janus kinase (JAK) inhibitors.
Further, the parameter suggested against the use of immunosuppressant medications such as baricitinib (Olumiant, Lilly), which is a JAK inhibitor, methotrexate and mycophenolate mofetil.
The parameter also suggested the consideration of cyclosporin in adults and adolescents who have refractory moderate to severe AD or who are intolerant of or unable to use mid- to high-potency topical treatment and biologics.
Finally, the parameter suggests against the use of systemic corticosteroids for AD.
References:
- AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel, et al. Ann Allergy Asthma Immunol. 2023;doi:10.1016/j.anai.2023.11.009.
- Golden DBK, et al. Ann Allergy Asthma Immunol. 2023;doi:10.1016/j.anai.2023.09.015.