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

BackgroundAnaphylaxis 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.ObjectivesTo assess the effectiveness of action plans as part of the long-term self-management of anaphylaxis in improving health outcomes.MethodsStandard 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of trials (http://www.clinicaltrials.gov, http://www.controlledtrials.com and http://www.nrr.nhs.uk) for published, unpublished and on-going randomized or quasi-randomized controlled trials of action plans in anaphylaxis management.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.ResultsNone of the 1026 potentially relevant studies identified fulfilled the inclusion criteria for this review.ConclusionsAlthough 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.