title: Evaluation of national institute of allergy and infectious diseases/food allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients.
abstract: BACKGROUND
  Diagnostic criteria 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). Validation is needed before these criteria can be widely adapted into clinical practice.
  
  
  OBJECTIVE
  Our aim was to retrospectively assess the diagnostic accuracy of the NIAID/FAAN criteria for the diagnosis of anaphylaxis in emergency department (ED) patients.
  
  
  METHODS
  A retrospective cohort study of ED patients presenting from April to October 2008 was conducted. Patients given a diagnosis of an allergic reaction or anaphylaxis and a subset of patients with related diagnoses were included. Electronic medical records were reviewed and data were abstracted to determine whether the NIAID/FAAN criteria were met. Records were also independently reviewed in a blinded fashion by 2 experienced attending allergists. Final diagnosis by allergists was considered the reference standard.
  
  
  RESULTS
  Of 214 patients, 86 (40.2%) met the NIAID/FAAN criteria for anaphylaxis. Allergists gave 61 (28.5%) patients diagnoses of anaphylaxis, 59 (96.7%) of whom satisfied the NIAID/FAAN criteria. The interrater agreement between allergists was substantial (κ = 0.77). The test characteristics of the NIAID/FAAN criteria were as follows: sensitivity, 96.7% (95% CI, 88.8% to 99.1%); specificity, 82.4% (95% CI, 75.5% to 87.6%); positive predictive value, 68.6% (95% CI, 58.2% to 77.4%); negative predictive value, 98.4% (95% CI, 94.5% to 99.6%); positive likelihood ratio, 5.48; and negative likelihood ratio, 0.04.
  
  
  CONCLUSIONS
  These results suggest that the NIAID/FAAN criteria are highly sensitive but less specific and are likely to be useful in the ED for the diagnosis of anaphylaxis.
authors: Department of Emergency Medicine, Mayo Clinic, Rochester, MN 55905, USA. campbell.ronna@mayo.edu
authors: Ronna L
authors: RL
authors: Campbell
authors: John B
authors: JB
authors: Hagan
authors: Veena
authors: V
authors: Manivannan
authors: Wyatt W
authors: WW
authors: Decker
authors: Abhijit R
authors: AR
authors: Kanthala
authors: Maria Fernanda
authors: MF
authors: Bellolio
authors: Vernon D
authors: VD
authors: Smith
authors: James T C
authors: JT
authors: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000707:Anaphylaxis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D057286:Electronic Health Records / Q000706:statistics & numerical data; D004632:Emergency Medical Services; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D054579:National Institute of Allergy and Infectious Diseases (U.S.); D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States