title: International consensus on (ICON) anaphylaxis.
abstract: ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction. They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice. For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences. ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available. ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research. IN ADDITION TO CONFIRMING THE ALIGNMENT OF MAJOR ANAPHYLAXIS GUIDELINES, ICON: Anaphylaxis adds value by including summary tables and citing 130 key references. It is published as an information resource about anaphylaxis for worldwide use by healthcare professionals, academics, policy-makers, patients, caregivers, and the public.
authors.affiliation: Department of Pediatrics & Child Health and Department of Immunology, Faculty of Medicine, University of Manitoba, Room FE125, 820 Sherbrook Street, Winnipeg, Manitoba, Canada, R3A 1R9.
authors.forename: F Estelle R
authors.initials: FE
authors.lastname: Simons
authors.affiliation: Cátedra Neumonología, Alergia e Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina.
authors.forename: Ledit Rf
authors.initials: LR
authors.lastname: Ardusso
authors.affiliation: Allergy Unit, Department of Internal Medicine, University Hospital, Ancona, Italy.
authors.forename: M Beatrice
authors.initials: MB
authors.lastname: Bilò
authors.affiliation: Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Cardona
authors.affiliation: Department of Allergy, National Hospital Organization, Sagamihara National Hospital, Clinical Research Center for Allergy & Rheumatology, Kanagawa, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Ebisawa
authors.affiliation: Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt.
authors.forename: Yehia M
authors.initials: YM
authors.lastname: El-Gamal
authors.affiliation: Allergy and Asthma Associates, Germantown, TN, USA.
authors.forename: Phil
authors.initials: P
authors.lastname: Lieberman
authors.affiliation: University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Lockey
authors.affiliation: Department of Women and Child Health, Food Allergy Referral Centre, University of Padua, Padua, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Muraro
authors.affiliation: University of Southampton Faculty of Medicine, Southampton, United Kingdom, David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Isle of Wight, United Kingdom.
authors.forename: Graham
authors.initials: G
authors.lastname: Roberts
authors.affiliation: Centro Medico Docente La Trinidad, Caracas, Clinica El Avila, Caracas, Venezuela.
authors.forename: Mario
authors.initials: M
authors.lastname: Sanchez-Borges
authors.affiliation: Center for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom and Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: Department of Pediatrics, National University of Singapore, Singapore.
authors.forename: Lynette P
authors.initials: LP
authors.lastname: Shek
authors.affiliation: Nova Southeastern University, Fort Lauderdale, FL, USA.
authors.forename: Dana V
authors.initials: DV
authors.lastname: Wallace
authors.affiliation: Allergie-Centrum-Charité, Klinik fur Dermatologie und Allergologie, Charité, Universitatsmedizin, Berlin, Germany.
authors.forename: Margitta
authors.initials: M
authors.lastname: Worm
keywords: Acute systemic allergic reaction; Anaphylaxis; Drug allergy; Epinephrine (adrenaline); Exercise-induced anaphylaxis; Food allergy; Glucocorticoids; H1-antihistamines; H2-antihistamines; Idiopathic anaphylaxis; Venom allergy