NIAID/FAAN criteria likely to improve emergency department anaphylaxis diagnosis
Published Online: November 3, 2011
Anaphylaxis, which has a wide spectrum of symptoms, is often unrecognized and subsequently undiagnosed by emergency care providers. This places patients at increased risk of potentially life-threatening future reactions. Currently, there are no universally accepted criteria to diagnose anaphylaxis, and this has contributed to the under-diagnosis of anaphylaxis in the emergency department (ED). Diagnostic criteria for anaphylaxis were proposed at the Second Symposium on the Definition and Management of Anaphylaxis convened by the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/ FAAN). However, evaluation of these criteria is necessary to determine their usefulness in clinical practice.
In a recent article in The Journal of Allergy and Clinical Immunology (JACI), Campbell et al assessed the diagnostic accuracy of the NIAID/FAAN criteria in ED patients. The researchers reviewed data from ED patient records to determine whether the NIAID/FAAN criteria were met. ED patient records were also independently reviewed by 2 experienced allergists to determine the final diagnosis.
The study results showed that that the NIAID/FAAN criteria were 96.7% sensitive, meaning that most patients who have anaphylaxis will meet NIAID/FAAN criteria. They also showed that the criteria were 82.4% specific, indicating that most patients who do not have anaphylaxis will not meet the NIAID/FAAN criteria. Based on these results, the authors concluded that the use of the NIAID/FAAN criteria in the ED will likely increase the recognition of anaphylaxis and improve ED anaphylaxis management.
Table 1. Clinical criteria for diagnosing anaphylaxis. Anaphylaxis is highly likely when any one of the following 3 criteria are fulfilled:
1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (eg, generalized hives, pruritus or flushing, swollen lips-tongue-uvula) AND AT LEAST ONE OF THE FOLLOWING
a. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
b. Reduced BP or associated symptoms of end-organ dysfunction (eg, hypotonia [collapse], syncope, incontinence)
2. Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours):
a. Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula)
b. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
c. Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence)
d. Persistent gastrointestinal symptoms (eg, crampy abdominal pain, vomiting)
3. Reduced BP after exposure to known allergen for that patient (minutes to several hours):
a. Infants and children: low systolic BP (age specific) or greater than 30% decrease in systolic BP*
b. Adults: systolic BP of less than 90 mm Hg or greater than 30% decrease from that person’s baseline
Footnote: PEF: Peak expiratory flow, BP: Blood pressure
Modified from Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF, Jr., Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium.[reprint in Ann Emerg Med. 2006 Apr;47(4):373-80; PMID: 16546624]. Journal of Allergy & Clinical Immunology. 2006 Feb;117(2):391-7.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.