To establish the effectiveness of interventions for the acute and long-term management of
anaphylaxis, seven databases were searched for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series and - only in relation to
adrenaline - case series investigating the effectiveness of interventions in managing
anaphylaxis. Fifty-five studies satisfied the inclusion criteria. We found no robust studies investigating the effectiveness of
adrenaline (
epinephrine), H1-antihistamines, systemic glucocorticosteroids or methylxanthines to manage
anaphylaxis. There was evidence regarding the optimum route, site and dose of administration of
adrenaline from trials studying people with a history of
anaphylaxis. This suggested that administration of intramuscular
adrenaline into the middle of vastus lateralis muscle is the optimum treatment. Furthermore, fatality register studies have suggested that a failure or delay in administration of
adrenaline may increase the risk of death. The main long-term management interventions studied were
anaphylaxis management plans and
allergen-specific
immunotherapy. Management plans may reduce the risk of further reactions, but these studies were at high risk of bias. Venom immunotherapy may reduce the incidence of systemic reactions in those with a history of
venom-triggered
anaphylaxis.