Updated Guidelines Announced for Clinicians Treating Atopic Dermatitis, Anaphylaxis

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These newly-updated parameters were a response by the ACAAI and the AAAAI to recent evidence that had become visible.

The collaborative task force of individuals from the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology (ACAAI), released 2 new evidence-based practice guidelines for the diagnosing and management of anaphylaxis and atopic dermatitis (AD).1

These newly-updated parameters were designed for both pediatric and adult patients, and the collaboration between the AAAAI and the ACAAI was titled the Joint Task Force for Practice Parameters (JTFPP). The new parameters emphasized updated recommendations in response to recently-emerging evidence and the necessity of evolving their guidelines.

“We regularly update our practice parameters to make sure allergists and other healthcare practitioners are aware of best practices when diagnosing and managing these disorders,” Jay Lieberman, MD, allergist and co-chair of the JTFPP Task Force, said in a statement. “When physicians and their staffs are aware of updated guidance, it means patients are getting the best, most appropriate care.”

Highlighted Updates to Anaphylaxis Guidelines:

The JTFPP updated recommendations related to whether a patient may be required to visit the emergency room if they utilize epinephrine in the case of anaphylaxis, with the group noting that emergency services (EMS) calls following epinephrine auto injector (EAI) use may not be necessary provided the patient has a complete, prompt, and durable response to their treatment and continues to maintain access to other EAIs.

They also noted that EMS activation may still be necessary in cases in which severe anaphylaxis occurs, if symptoms do not resolve quickly, completely, or nearly completely, or in cases in which symptoms are seen again or even become worse. The JTFPP also made updates to recommendations related to auto-injector storage practices.

As far as diagnosis of patients’ anaphylaxis, the JTFPP noted that revised criteria made by the World Allergy Organization (WAO), Brighton, and Delphi Consensus groups were designed to allow for more widely-used anaphylactic reaction criteria and word definitions. Diagnosis of infants does not have any age-specific criteria, so the organization emphasized the importance of using the National Institute of Allergy and Infectious Diseases/Food Allergy & Anaphylaxis Network or World Allergy Organization’s current anaphylaxis criteria for infants/toddlers.

The group also made updates related to ways in which evaluation and treatment of anaphylaxis should occur related to surgery. They also updated parameters related to the nuances of implementing beta-blockers and ACE inhibitors among those who are found to be at risk.

Highlighted Updates to Atopic Dermatitis Guidelines:

The JTFPP also emphasized topical calcineurin inhibitor safety with typical usage on a regimen of once or twice-per-day, adding that they endorse proactive therapy implementation with topical calcineurin inhibitors or topical corticosteroids for those with a relapsing course. The group also included a recommendation of topical corticosteroids or topical calcineurin inhibitor use in their guidelines for people shown to have uncontrolled AD even with moisturizers.

The group recommended considering once-per-day dosing of patients’ topical medications. Their guideline updates also included an endorsement of dupilumab for individuals aged 6 months or older that have moderate-severe AD refractory, intolerant, or unable to make use of mid-potency topical therapies, and they recommend tralokinumab for such individuals in the age bracket of 12 years and up.

Elimination diets were emphasized by the JTFPP for those with AD as well. They further highlighted the implementation of crisaborole 2% ointment for patients with mild-to-moderate AD and indicated a lack of support for topical antibiotics in patients with AD alone that do not have infection.

For those with moderate to severe cases of AD, the group recommended bleach baths as an additive therapy, though they did not recommend this for mild cases. They also endorsed consideration of implementing allergen immunotherapy for individuals that have moderate to severe disease.

For both adults and adolescents that have moderate-severe eczema refractory, intolerant, or unable to utilize mid to high potency topical therapies as well as biologics, the JTFPP endorsed the implementation of oral JAK inhibitors following a risk/benefit analysis. The group also spoke against using immunosuppressant medications like azathioprine, baricitinib, mycophenylate mofetil, and methotrexate.

Lastly, the JTFPP emphasized the value of considering using cyclosporin for patients in the adults or adolescent age range that have moderate-severe disease refractory, intolerant, or unable to utilize mid to high potency biologics and topical therapies. They added that they do not recommend using systemic corticosteroids for patients with AD as well.

For full understanding, the reader should read more about the updated practice parameters that have been published in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma & Immunology.

References

  1. New guidelines released for practitioners treating anaphylaxis and atopic dermatitis. Scienmag. December 18, 2023. https://scienmag.com/new-guidelines-released-for-practitioners-treating-anaphylaxis-and-atopic-dermatitis/. Date accessed: December 18, 2023.
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