Evaluation of national institute of allergy and infectious diseases/food allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients

Ronna L. Campbell, John B. Hagan, Veena Manivannan, Wyatt W. Decker, Abhijit R. Kanthala, Fernanda Bellolio, Vernon D. Smith, James T C Li

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Background: Diagnostic criteria were proposed at the Second Symposium on the Definition and Management of Anaphylaxis convened by the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN). Validation is needed before these criteria can be widely adapted into clinical practice. Objective: Our aim was to retrospectively assess the diagnostic accuracy of the NIAID/FAAN criteria for the diagnosis of anaphylaxis in emergency department (ED) patients. Methods: A retrospective cohort study of ED patients presenting from April to October 2008 was conducted. Patients given a diagnosis of an allergic reaction or anaphylaxis and a subset of patients with related diagnoses were included. Electronic medical records were reviewed and data were abstracted to determine whether the NIAID/FAAN criteria were met. Records were also independently reviewed in a blinded fashion by 2 experienced attending allergists. Final diagnosis by allergists was considered the reference standard. Results: Of 214 patients, 86 (40.2%) met the NIAID/FAAN criteria for anaphylaxis. Allergists gave 61 (28.5%) patients diagnoses of anaphylaxis, 59 (96.7%) of whom satisfied the NIAID/FAAN criteria. The interrater agreement between allergists was substantial (κ = 0.77). The test characteristics of the NIAID/FAAN criteria were as follows: sensitivity, 96.7% (95% CI, 88.8% to 99.1%); specificity, 82.4% (95% CI, 75.5% to 87.6%); positive predictive value, 68.6% (95% CI, 58.2% to 77.4%); negative predictive value, 98.4% (95% CI, 94.5% to 99.6%); positive likelihood ratio, 5.48; and negative likelihood ratio, 0.04. Conclusions: These results suggest that the NIAID/FAAN criteria are highly sensitive but less specific and are likely to be useful in the ED for the diagnosis of anaphylaxis.

Original languageEnglish (US)
Pages (from-to)748-752
Number of pages5
JournalJournal of Allergy and Clinical Immunology
Volume129
Issue number3
DOIs
StatePublished - Mar 2012

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National Institute of Allergy and Infectious Diseases (U.S.)
Food Hypersensitivity
Anaphylaxis
Hospital Emergency Service
Electronic Health Records

Keywords

  • Anaphylaxis
  • diagnostic criteria
  • test characteristics

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Evaluation of national institute of allergy and infectious diseases/food allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients. / Campbell, Ronna L.; Hagan, John B.; Manivannan, Veena; Decker, Wyatt W.; Kanthala, Abhijit R.; Bellolio, Fernanda; Smith, Vernon D.; Li, James T C.

In: Journal of Allergy and Clinical Immunology, Vol. 129, No. 3, 03.2012, p. 748-752.

Research output: Contribution to journalArticle

Campbell, Ronna L. ; Hagan, John B. ; Manivannan, Veena ; Decker, Wyatt W. ; Kanthala, Abhijit R. ; Bellolio, Fernanda ; Smith, Vernon D. ; Li, James T C. / Evaluation of national institute of allergy and infectious diseases/food allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients. In: Journal of Allergy and Clinical Immunology. 2012 ; Vol. 129, No. 3. pp. 748-752.
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abstract = "Background: Diagnostic criteria were proposed at the Second Symposium on the Definition and Management of Anaphylaxis convened by the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN). Validation is needed before these criteria can be widely adapted into clinical practice. Objective: Our aim was to retrospectively assess the diagnostic accuracy of the NIAID/FAAN criteria for the diagnosis of anaphylaxis in emergency department (ED) patients. Methods: A retrospective cohort study of ED patients presenting from April to October 2008 was conducted. Patients given a diagnosis of an allergic reaction or anaphylaxis and a subset of patients with related diagnoses were included. Electronic medical records were reviewed and data were abstracted to determine whether the NIAID/FAAN criteria were met. Records were also independently reviewed in a blinded fashion by 2 experienced attending allergists. Final diagnosis by allergists was considered the reference standard. Results: Of 214 patients, 86 (40.2{\%}) met the NIAID/FAAN criteria for anaphylaxis. Allergists gave 61 (28.5{\%}) patients diagnoses of anaphylaxis, 59 (96.7{\%}) of whom satisfied the NIAID/FAAN criteria. The interrater agreement between allergists was substantial (κ = 0.77). The test characteristics of the NIAID/FAAN criteria were as follows: sensitivity, 96.7{\%} (95{\%} CI, 88.8{\%} to 99.1{\%}); specificity, 82.4{\%} (95{\%} CI, 75.5{\%} to 87.6{\%}); positive predictive value, 68.6{\%} (95{\%} CI, 58.2{\%} to 77.4{\%}); negative predictive value, 98.4{\%} (95{\%} CI, 94.5{\%} to 99.6{\%}); positive likelihood ratio, 5.48; and negative likelihood ratio, 0.04. Conclusions: These results suggest that the NIAID/FAAN criteria are highly sensitive but less specific and are likely to be useful in the ED for the diagnosis of anaphylaxis.",
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AU - Manivannan, Veena

AU - Decker, Wyatt W.

AU - Kanthala, Abhijit R.

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AU - Smith, Vernon D.

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