The College recently was a key expert organization contributing to the latest practice parameters in allergy/immunology.
I hope you’ve had a chance to review these two new practice parameters from the Allergy/Immunology Joint Task Force on Practice Parameters (JTFPP) – one on anaphylaxis and the other on atopic dermatitis. They offer evidence-based recommendations for the diagnosis and management of these conditions in pediatric and adult patients. Both were published online in the Annals of Allergy, Asthma & Immunology on Dec. 17, and they will appear in a print issue of Annals in the near future.
As a reminder, the Joint Task Force is a partnership between the American College of Allergy, Asthma & Immunology (ACAAI) and the American Academy of Allergy, Asthma & Immunology (AAAAI). For each parameter that is newly developed or updated, members of ACAAI as well as AAAAI serve as authors. These authors are recognized experts in the topics at hand. All current parameters can be found at www.allergyparameters.org
Why should we pay attention to these guidelines? The answer is because they are produced using stringent processes for collecting, analyzing and reporting the latest evidence, whether that entails the GRADE process or other steps. Therefore, they tell us the latest knowledge and best practices related to the diagnosis and treatment of conditions.
When a new or updated practice parameter is released, its effects trickle down through all aspects of College materials and resources – from clinical yardsticks and online courses to patient information and Annual Scientific Meeting sessions.
We know that other organizations will adapt their information to reflect the latest updates as well. In fact, that is one of the reasons why these parameters are open to the public – so that everyone in health care can benefit from the information, which will ultimately benefit our patients.
I’ll mention a few top highlights of the new/updated anaphylaxis and atopic dermatitis guidelines here, but I urge you to review the full documents.
Anaphylaxis (Lead Author: David B.K. Golden, MDCM)
The practice parameter on anaphylaxis focuses on areas where new evidence has emerged, and recommendations have evolved.
Key anaphylaxis guideline highlights include:
- Updates on recommendations regarding if a patient must go to the emergency room if they use epinephrine for anaphylaxis. Calling emergency services (EMS) after use of an epinephrine auto injector (EAI) may not be required if the patient experiences prompt, complete, and durable response to treatment and has access to additional EAIs. Situations that would warrant EMS activation include severe anaphylaxis, symptoms that do not resolve promptly, completely or nearly completely, or symptoms that return or worsen.
- Recommendations on how, where and by whom epinephrine auto injectors should be stored.
- Updates on the diagnosis of anaphylaxis. Revised criteria by the World Allergy Organization (WAO), Brighton, and Delphi Consensus groups aim to create more universally accepted definitions and criteria for anaphylactic reactions.
- Updates on how to recognize and treat anaphylaxis in infants. Diagnosing anaphylaxis in infants and toddlers can be challenging, and there are no age-specific anaphylaxis diagnostic criteria. Therefore, the current National Institute of Allergy and Infectious Diseases/Food Allergy & Anaphylaxis Network or World Allergy Organization anaphylaxis criteria should be used to establish the diagnosis of anaphylaxis in infants/toddlers.
- Updates on how to evaluate and treat anaphylaxis in relation to a surgery.
- Updates on nuances regarding the use of beta-blockers and ACE inhibitors in patients at risk for anaphylaxis.
Atopic Dermatitis (Lead Author: Derek Chu, MD, PhD)
Developed in adherence with the GRADE process, 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. The new recommendations also reflect the evolution of diversity, equity and inclusion in approaching diagnosis and management of this condition.
Key atopic dermatitis guideline highlights include:
- Recommends the use of topical corticosteroids or topical calcineurin inhibitors in patients with uncontrolled AD, despite moisturizers.
- Highlights the safety of the topical calcineurin inhibitors with typical usage once or twice daily.
- Recommends proactive therapy with topical corticosteroids or topical calcineurin inhibitors for patients with a relapsing course.
- Consideration for once daily dosing of topical medications. Recommends dupilumab for patients 6 months of age or older with moderate-severe AD refractory, intolerant, or unable to use mid-potency topical treatment, or tralokinumab for similar patients ages 12 years and older.
- Suggested uses of medications including crisaborole 2% ointment, JAK inhibitors and cyclosporin as well as biologics.
- Suggested uses for bleach baths as therapy.
- Suggests against the use of topical antibiotics for AD alone with no infection.
- Consideration of immunotherapy for moderate to severe AD.
- Many more details on suggested use of (or suggesting against the use of) various treatments.
Kudos to the entire Joint Task Force, chaired by Drs. Jay Lieberman and Marcus Shaker.
To read more about the most recent practice parameters:
Review Anaphylaxis: A 2023 practice parameter update for complete recommendations.
Review Atopic Dermatitis (Eczema) Guidelines: 2023 AAAAI/ACAAI Joint Task Force (JTF) on Practice Parameters GRADE for complete recommendations.
In addition to the two recently released parameters, the JTFPP is actively developing clinical guidelines on inborn errors of immunity, allergen immunotherapy, severe asthma, chronic urticaria, vaccine allergy, and food allergy, with recent guidelines available on drug allergy, chronic sinusitis, allergy diagnostics, eosinophilic esophagitis, allergic rhinitis, and stinging insect allergy available at www.allergyparameters.org
I hope you will find these new guidelines to be helpful in providing the most up-to-date care for your patients.