Action plans for the long-term management of anaphylaxis: Systematic review of effectiveness

Background: Anaphylaxis is a severe, potentially life-threatening allergic reaction. Most reactions occur in the absence of a healthcare professional and there is a considerable risk of recurrence in those with a past history of anaphylaxis. The concept of action plans has been developed to facilitate long-term self-management of chronic disorders with a view to promoting patient empowerment and improving health outcomes. Although increasingly advocated for use in anaphylaxis, the effectiveness of this approach in this context is unknown. Objectives: To assess the effectiveness of action plans as part of the long-term self-management of anaphylaxis in improving health outcomes. Methods: Standard systematic review techniques were used. We searched CENTRAL, Cochrane, Medline and Embase databases, contacted an international panel of anaphylaxis experts and relevant pharmaceutical companies and searched key web-based databases of trials (www.clinicaltrials.gov, www.controlledtrials.com and www.nrr.nhs.uk) for published, unpublished and on-going randomized or quasi-randomized controlled trials of action plans in anaphylaxis management. There was no restriction used with respect to the language of publication. Searches were completed in summer 2006. Results: None of the 1026 potentially relevant studies identified fulfilled the inclusion criteria for this review. Conclusions: Although there are potential major benefits of routinely issuing anaphylaxis action plans, there is currently no robust evidence to guide clinical practice. Pragmatic randomized-controlled trials of anaphylaxis action plans are urgently needed; in the meantime, national and international guidelines should make clear this major gap in the evidence base. © 2007 Blackwell Publishing Ltd.