Citation

Abrams EM, Greenhawt M, Alqurashi W, Singer AG, Shaker M. J. Allergy Clin. Immunol. Pract. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Elsevier Publishing)

DOI

10.1016/j.jaip.2021.05.038

PMID

unavailable

Abstract

Overdiagnosis of anaphylaxis-risk is an underappreciated aspect of anaphylaxis prevention. While the benefits of anaphylaxis-risk prevention are well-known, potential harms resulting from pre-emptive approaches to mitigate anaphylaxis-risk are not insignificant. Still, great progress has been made in recent years to avoid the unintended consequences of anaphylaxis-risk overdiagnosis. Reflection on recent advances in the use of diagnostic testing, as well as the application of diagnostic labels, provides an important perspective to understand how far the specialty of allergy and immunology has come in improving the lives of patients and families. Examples of recent paradigm shifts in anaphylaxis risk management include approaches to peanut allergy prevention without screening, deferral of corticosteroids to prevent biphasic anaphylaxis reactions, re-evaluation of reflex use of emergency medical services for resolved community anaphylaxis, and an approach to penicillin allergy delabeling with direct oral challenge. Routine medical practices to decrease anaphylaxis-risk can have lifelong impacts for patients - beyond just preventing anaphylaxis. As our understanding of these trade-offs evolves it becomes necessary to weigh both the benefits and the harms of past management approaches. Because medicine remains a science of uncertainty and an art of probability, a critical approach to risk mitigation remains necessary to find the often elusive balance in anaphylaxis prevention.

Language: en

Keywords

COVID-19; anaphylaxis; risk communication; SARS-CoV-2