Glucocorticoids for the treatment of anaphylaxis

Background Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may result in death. Anaphylaxis guidelines recommend glucocorticoids for the treatment of people experiencing anaphylaxis. Objectives We sought to assess the benefits and harms of glucocorticoid treatment during episodes of anaphylaxis. Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 3), MEDLINE (Ovid) (1966 to September 2009), EMBASE (Ovid) (1988 to September 2009), CINAHL (EBSCOhost) (to September 2009) and The Science Citation Index Expanded (SCI-EXPANDED) (1945 to September 2009). We also searched the UK National Research Register and websites listing ongoing trials, and contacted international experts in anaphylaxis in an attempt to locate unpublished material. Selection criteria We included randomized and quasi-randomized controlled trials comparing glucocorticoids with any control (either placebo, adrenaline (epinephrine), an antihistamine, or any combination of these). Data collection and analysis Two authors independently assessed articles for inclusion. Main results We found no studies that satisfied the inclusion criteria. Authors' conclusions We are, based on this review, unable to make any recommendations for the use of glucocorticoids in the treatment of anaphylaxis. Glucocorticoids for the treatment of anaphylaxis Anaphylaxis is a serious allergic reaction that is rapid in onset and may result in death. It is commonly triggered by a food, insect sting, medication, or natural rubber latex. The reaction typically occurs without warning and can be a frightening experience both for those at risk and their families and friends. Steroids (glucocorticoids) are often recommended for use in the management of people experiencing anaphylaxis. However, the evidence base in support of the use of steroids is unclear. We therefore conducted a systematic review of the literature, searching key databases for high quality published and unpublished material on the use of steroids for the emergency treatment of anaphylaxis. In addition, we contacted experts in this health area and the relevant pharmaceutical companies. We were unable to find any randomized controlled trials on this subject through our searches. We conclude that there is no evidence from high quality studies for the use of steroids in the emergency management of anaphylaxis. Therefore, we can neither support nor refute the use of these drugs for this purpose.