New consensus report on anaphylaxis: A major advancement in allergy care

New tool offers fresh guidelines for first responders, emergency care providers, allergists, and others, including how to manage infants

Cincinnati Children's Hospital Medical Center

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The new guidelines reflect the efforts of a 46-member panel of experts from 14 countries and seven medical specialties. The findings have received endorsements from 34 medical and patient advocacy organizations. The National Institutes of Health, the U.S. Food and Drug Administration, and the European Medicines Agency all participated in the study.

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Credit: Source: JACI

A groundbreaking consensus report on anaphylaxis – the severe reaction some people experience from bee stings, peanut butter exposures, medications, and the like – has been released by the Global Allergy and Asthma Excellence Network (GA2LEN) and recently published in The Journal of Allergy and Clinical Immunology.

The report, developed by an international panel of leading medical experts and patient advocacy organizations, aims to standardize the often-differing definitions of anaphylaxis and teach people how to recognize and manage the condition.

“Many people, including young children and adults, carry epinephrine-injectors (aka epi-pens) to self-treat if an emergency occurs. Many others do not. Likewise, our sprawling medical system, from first responders to hospital emergency staff, does not consistently follow guidelines for diagnosing and treating anaphylaxis. This is partly because no uniform guidelines are used internationally to define, recognize and treat anaphylaxis. That’s what this report seeks to address,” says Tim Dribin, MD, an emergency medicine expert at Cincinnati Children’s and the study’s co-chair who devoted a year to leading the group that produced the new standards.

“This tool includes updated clinical criteria to help diagnose anaphylaxis, criteria for using and dosing intramuscular epinephrine, and much more. Importantly, this is the first tool to include distinct infant findings to improve anaphylaxis management in young children,” Dribin says.

Burden of Anaphylaxis

Anaphylaxis is a constant burden to patients and caregivers around the world. At any moment, thousands of people encounter situations that could cause severe allergic reactions, with symptoms including hives, swollen lips and tongue, difficulty breathing, wheezing, vomiting, and passing out. While fatalities are rare, successful outcomes require rapid recognition and treatment.

Epinephrine is the only proven anaphylaxis treatment to reduce the risk of hospitalization and death. However, only 21% of children and 7% of adults experiencing anaphylaxis receive epinephrine in the community.  Additionally, epinephrine underuse in emergency departments is well-documented.

Expert Collaboration

The new report reflects the efforts of a 46-member panel of experts from 14 countries and seven medical specialties. The findings have received endorsements from 34 medical and patient advocacy organizations.  The National Institutes of Health, the U.S. Food and Drug Administration, and the European Medicines Agency all participated in the study.

"The clinical support tool is a game-changer in anaphylaxis management,” says Hugh Sampson, MD, an internationally renowned food allergy and anaphylaxis expert at Mount Sinai School of Medicine and the study’s chair. “By improving the rate of epinephrine use, we can significantly reduce the risk of severe reactions and fatalities, ultimately saving lives. The report will also be instrumental for advancing cutting edge research to improve the care and outcomes of patients with anaphylaxis."

"I believe the elements of this report will help ensure that patients around the world receive timely and appropriate treatment, potentially saving lives," says Antonella Muraro, MD, PhD, an internationally renowned pediatric allergist at the University of Padova in Italy and the study’s co-chair. “The report will be invaluable to first responders, emergency department providers, hospital providers, and allergists, as well as researchers trying to better understand and manage this serious and burdensome condition.”

Key Highlights of the Report

1. Unified Definition: The report introduces a new, widely agreed upon definition of anaphylaxis, emphasizing its potential to cause death and detailing the involved organ systems. This definition is designed to be easily understood by healthcare professionals and the general public to promote improved awareness of anaphylaxis.
2. Educational Overview: An innovative educational tool for healthcare professionals from different medical fields, training backgrounds, and experience levels. The overview provides essential information on recognizing and managing anaphylaxis, including common causes, symptoms, timely treatment with epinephrine, and key concepts for managing life-threatening reactions.
3. Clinical Support Tool: A new clinical support tool will help healthcare providers diagnose and treat anaphylaxis. This tool includes updated clinical criteria, indications, and dosing for intramuscular epinephrine and common findings from the different anaphylaxis organ systems. It is the first tool to include distinct infant findings to improve anaphylaxis management in young children, benefiting healthcare providers not accustomed to caring for children.

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Journal

Journal of Allergy and Clinical Immunology

DOI

10.1016/j.jaci.2025.01.021 

Article Title

Anaphylaxis definition, overview, and clinical support tool: 2024 consensus report

COACHING IS ABUSE

Nearly 4 of 10 Americans report sports-related mistreatment

Weight issues the most common reason for abuse

Ohio State University

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Nearly 40% of adult Americans say they’ve experienced some type of sport-related mistreatment in their lives, a new study shows.

 

Mistreatment ranged from psychological and emotional to physical and sexual. But most people who reported mistreatment experienced more than one kind, the research found.

 

And one-third of those who never even played organized sports reported sports-related mistreatment.

 

“Many people talk about how they hated middle school or high school because of recess or gym class and the abuse or shame they felt playing sports in that environment,” said Chris Knoester, co-author of the study and professor of sociology at The Ohio State University.

 

“It just speaks to the pervasiveness of sport-related mistreatment in our society that we document in this research.”

 

The study, published online recently in the International Journal of the Sociology of Leisure, was led by Mariah Warner, a doctoral student in sociology at Ohio State.

 

The study used survey data on 3,849 adults who participated in the  National Sports and Society Survey (NSASS), sponsored by Ohio State’s Sports and Society Initiative. Those surveyed volunteered to participate through the American Population Panel, run by Ohio State’s Center for Human Resource Research. Participants, who came from all 50 states, answered the survey online between the fall of 2018 and spring of 2019.

 

Overall, 38% responded yes to the question “have you ever been mistreated in your sports interactions.” They weren’t asked in what context they were mistreated, but the fact that many people who reported mistreatment said they had not played organized sports suggests it could have occurred during school recess, physical education classes, informal play with peers, or even while watching sports, Knoester said.

 

Psychological or emotional mistreatment was most common, cited by 64% of those who were mistreated, followed by hate speech and discrimination. About one-quarter of those reporting mistreatment said it was physical in nature, while 10% said it was sexual.

 

“The amount of mistreatment people report is remarkable.  It really stands in contrast to the myth that sports are all good and wholesome and positive for those who play,” Knoester said.

 

The most common reason people reported for abuse was because of their weight, cited by 52% of mistreated respondents. That makes sense in terms of what happens in many schools, he said.

 

“Physical education classes and recess put your bodies on display in ways that don’t happen too commonly otherwise,” he noted.

 

“And obviously weight is something that people observe and classmates or people in public may be quick to mistreat or ridicule others if their weight doesn’t conform to cultural expectations.”

 

After weight, the most commonly noted reasons for mistreatment were gender (34%), sexual identity (20%), race or ethnicity (19%), disability status (12%) and religion (11%).

 

Unsurprisingly, in light of traditional jock cultures, people who were successful students and less athletic reported more mistreatment, Knoester said.

 

Elite sports and more competitive settings also seemed to be more prone for mistreatment to happen.

 

Yet, strikingly, it was men and white people who were most likely to face sports-related mistreatment, results showed.

 

Other research shows that Black people tend to recognize sports as relatively more positive environments for social interactions and feedback, which may be why they report less mistreatment, Knoester said.

 

And for men, the culture of masculinity in sports may make ridicule, fighting, hazing and other forms of mistreatment more common than they are for women, he added.

 

Knoester said that while the study suggests sports-related mistreatment is common, the results may still underestimate how much really occurs.

 

“These were adults remembering events from their childhood, so there may be a problem with recall,” he said. “And Americans are generally positive about sports, so they may not be inclined to report bad things that happened to them in that context.”

 

Knoester said he hopes the study helps bring attention to an aspect of sports that people don’t normally want to talk about.

 

“Sports-related interactions aren’t always positive.  I think it is important to better understand how frequently negative interactions occur and what we can do as a society to improve the culture of sports, otherwise there is not a means in place for betterment,” he said.

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Journal

International Journal of the Sociology of Leisure

DOI

10.1007/s41978-025-00176-6 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Sports-related Mistreatment in the U.S.: Retrospective Recognitions and Connections to Social Structural Locations, Childhood Contexts, and Adult Characteristics

 

Anxiety sensitivity led to pandemic problem drinking, new Concordia study shows

Consuming alcohol to cope with fears around experiencing anxiety was linked to unhealthy outcomes in young adults

Concordia University

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Charlotte Corran

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Credit: Concordia University

The link between alcohol consumption and anxiety had been established long before the stressful early days of the COVID-19 pandemic. Much of the world will mark the fifth anniversary of the global lockdown in the coming weeks.

For many young adults with anxiety sensitivity — the fear of experiencing anxiety symptoms and the negative health, social and emotional outcomes associated with them — alcohol use became a way to cope with those fears. But as a new Concordia study shows, drinking to cope with fears of anxiety probably made them feel worse.

The study, published in the Journal of American College Health, reveals that drinking to cope put young adults with anxiety sensitivity at further risk of problematic drinking and the negative consequences associated with it.

Anxiety sensitivity was also found to predict higher alcohol use — heavy but not the kind of problematic drinking that significantly interfered with school or work. This higher use was mainly ascribed to perceived stress and drinking for enhancement or sociability.

“We were surprised to find that perceived stress did not explain the link between anxiety sensitivity and problem drinking,” says lead author Charlotte Corran, a PhD candidate in the Department of Psychology in the Faculty of Arts and Science.

The researchers suggest that people high in anxiety sensitivity are at increased risk of drinking to cope regardless of their level of stress — a finding they describe as unexpected.

They speculate that the unique circumstances of the pandemic may have confounded their own expectations, and/or that the baseline level of hypervigilance to stress among people with anxiety sensitivity was already elevated.

“For those cases, the pandemic didn’t add anything new: ‘I’m already stressed all the time, so this isn’t anything different.’”

Lessons from a stressful time

“These findings confirmed the risky pathways to drinking that we knew of pre-pandemic and gave us an interesting snapshot of what was going on with these people who are high in anxiety sensitivity during the pandemic,” Corran says.

The study used data collected from 143 undergraduate students in May 2020 and April 2021. These included a 16-point self-report Anxiety Sensitivity Index questionnaire assessing sensitivity to anxious symptoms and fear of negative consequences, a four-item Perceived Stress Scale to assess subjective stress (e.g., “In the last month, how often have you felt that things have gone your way?”) and a 28-item Modified Drinking Motives Questionnaire modified to capture drinking motives during the pandemic.

The latter comprised five subscales measuring coping-anxiety (“You drink because it helps you when you feel nervous”), coping-depression (“You drink because it helps you when you feel depressed”), enhancement (“You drink because you like the feeling”), sociability (“You drink to be sociable”) and conformity (“You drink to fit in with a group you like”).

Participants were also asked to record how many drinks they consumed during a typical week since the start of the pandemic and complete a 24-item questionnaire assessing problem drinking behaviour frequency (eg., “I passed out from drinking”) during a typical week.

“These findings will continue to inform clinical practice, intervention, psychotherapy, cognitive behaviour therapy, understanding the mechanisms of risks and trying to find more adaptive ways to cope other than turning to alcohol,” Corran explains. “It can also help us continue to try to understand the beliefs or cognitions that are involved in problematic behaviour.”

The Social Studies and Humanities Research Council of Canada (SSHRC) provided funding for this research.

Professor Roisin O’Connor from Concordia’s Department of Psychology and Paul Norman of the University of Sheffield contributed to this study.

Read the cited paper: “Young adult drinking during the COVID-19 pandemic: Examining the role of anxiety sensitivity, perceived stress, and drinking motives.”

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Journal

Journal of American College Health

DOI

10.1080/07448481.2024.2440761 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Young adult drinking during the COVID-19 pandemic: Examining the role of anxiety sensitivity, perceived stress, and drinking motives

 

Research spotlight: Identifying intimate partner violence with a radiology screening tool

Mass General Brigham

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Patrick Lenehan, MD, PhD and Anji Tang, MD are co-first authors, and Bharti Khurana, MD, MBA, in the Department of Radiology Trauma Imaging Research and Innovation Center (TIRIC) at Brigham and Women’s Hospital, is the corresponding author of a paper published in the Journal of the American College of Radiology (JACR), “Utilizing Radiology as a Screening Tool to Identify Intimate Partner Violence.”

How would you summarize your study for a lay audience?

Intimate partner violence (IPV) is very common, with over 40% of women in the United States experiencing IPV throughout their lifetime. Alarmingly, it is estimated that about half of female homicides in the United States and internationally are related to IPV. Reporting IPV to clinicians or other members of the healthcare system is often not possible, deferred, or delayed, leading to repeated cycles of abuse or aggression. However, patients experiencing IPV do frequently seek help from healthcare providers for physical and psychological injuries associated with IPV, even if they have not yet reported it.

We performed this study to inform radiologists about the imaging and injury patterns associated with IPV so they can be better equipped to help identify these patients earlier.

What question were you investigating?

We wanted to understand how radiological imaging and evident injury patterns differ between women who have reported IPV and women who have not.

What approach did you use?

In this study, we compared the amount, types, and timing of imaging studies and injury patterns between patients experiencing IPV (the “case” cohort) and patients who have not reported IPV (the “control” cohort). We gathered all patients’ prior imaging studies and asked radiologists to analyze them retrospectively. They reviewed the radiology reports and recorded the type and anatomical location of any injuries. We also recorded the day of the week, time of day, and clinical setting (e.g., Emergency Department) where each image was taken, allowing us to compare these features between the case and control cohorts.

What did you find?

We determined that patients experiencing IPV:

1. Underwent more imaging studies than controls and tended to have a disproportionate amount of their imaging performed during overnight and weekend periods
2. Had a higher rate of radiologically evident injuries across most anatomic sites and had distinctive injury patterns, with particularly high rates of injuries to the head, face, and thorax
3. Were more likely to experience synchronous injuries (at least two unique injuries identified during a single clinical encounter) and asynchronous injuries (at least two unique injuries identified during separate clinical encounters)

What are the implications?

This work has the potential to help patients by enabling radiologists to detect IPV earlier. It is well known that the experience of IPV often goes unrecognized across repeated clinical encounters. We hope this work can help shorten the time between the initial clinical presentation and the time of IPV recognition.

What are the next steps?

The Journal of American Radiology will disseminate our findings through continuing medical education (CME) credit to radiologists so that they can more accurately raise suspicion for IPV and effectively communicate this with patient-facing clinicians. We also aim to develop artificial intelligence (AI)-enabled clinical decision support tools that leverage imaging and other data to quantify real-time IPV risk for individual patients.

Authorship: In addition to Lenehan, Tang, and Khurana, Mass General Brigham authors include Gaurav V Watane, Rahul Gujrathi, Hyesun Park, Babina Gosangi, Richard Thomas, Felipe Boschini Franco, Ilana Warsofsky, and Bernard Rosner. Additional authors include Krishna Patel.

Paper cited: Lenehan P, Tang A, et al., “Utilizing Radiology as a Screening Tool to Identify Intimate Partner Violence,” Journal of the American College of Radiology (JACR) DOI:  10.1016/j.jacr.2025.01.00

Funding: This work was supported by the American College of Radiology Innovation Fund.

Disclosures: Patrick J. Lenehan reports a relationship with nference, Inc. that includes employment and equity or stocks.

 

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Journal

Journal of the American College of Radiology

DOI

10.1016/j.jacr.2025.01.00 

Method of Research

Imaging analysis

Subject of Research

Not applicable

Article Title

Using Radiology as a Screening Tool to Identify Intimate Partner Violence

Article Publication Date

4-Mar-2025

COI Statement

Patrick J. Lenehan, MD, PhD, reports a relationship with nference, Inc, that includes: employment and equity or stocks. The other authors state that they have no conflict of interest related to the material discussed in this article. All authors are non-partner/non-partnership track/employees.

 

Teachers' negative emotions impact engagement of students, new study finds

In a new study, about 10% of teachers displayed notable amounts of negative emotions — as much as 80% of their instructional time. The students of these teachers reported reduced enjoyment and engagement in class.

University of Delaware

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In their study, University of Delaware Associate Research Professor Leigh McLean and co-author Nathan Jones of Boston University, found that teachers displayed far more positive emotions than negative ones. But they also found that some teachers showed high levels of negative emotions. In these cases, teachers’ expressions of negative emotions were associated with reduced student enjoyment of learning and engagement. These findings add to a compelling body of research highlighting the importance of teachers’ and students’ emotional experiences within the context of teaching and learning. 

“Anyone who has been in a classroom knows that it is an inherently emotional environment, but we still don’t fully understand exactly how emotions, and especially the teachers’ emotions, work to either support or detract from students’ learning,” said McLean, who studies teachers’ emotions and well-being in the College of Education and Human Development’s School of Education (SOE) and Center Research in Education and Social Policy (CRESP). “This new tool, and these findings, help us understand these processes more precisely and point to how we might provide emotion-centered classroom supports.” 

Using the new observational tool they developed—the Teacher Affect Coding System—McLean and Jones also assessed teachers’ vocal tones, body posturing, body movements and facial expressions during classroom instruction and categorized outward displays of emotion as positive, negative or neutral. For example, higher-pitched or lilting vocal tones were categorized as positive, while noticeably harsh or sad vocal tones were categorized as negative. 

Overall, McLean and Jones found that teachers spent most of their instructional time displaying outward positive emotions.

However, they did find that a small subset of teachers—about 10%—displayed notable amounts of negative emotions, with some showing negativity during as much as 80% of their instructional time. The students of these teachers reported reduced enjoyment and engagement in their ELA classes and reduced engagement in their math classes. 

“We think that these teachers are struggling with their real-time emotion regulation skills,” McLean said. “Any teacher, even a very positive one, will tell you that managing a classroom of students is challenging, and staying positive through the frustrating times takes a lot of emotional regulation. Emotion regulation is a particularly important skill for teachers because children inherently look to the social cues of adults in their immediate environment to gauge their level of safety and comfort. When a teacher is dysregulated, their students pick up on this in ways that can detract from learning.”

Recommendations for supporting teacher well-being 

Given the findings of their study, McLean and Jones make several recommendations for teacher preparation and professional learning programs. As a first step, they recommend that teacher preparation and professional learning  programs share information about how negative emotions and experiences are a normal part of the teaching experience. As McLean said, “It’s okay to be frustrated!”

However, it is also important to be aware that repeated outward displays of negative emotion can impact students. McLean and Jones also suggest that these programs provide specific training to teachers on skills such as mindfulness and emotion regulation to help teachers manage negative emotions while they’re teaching. 

“Logically, these findings and recommendations make complete sense,” said Steve Amendum, professor and director of CEHD’s SOE, which offers a K-8 teacher education program. “After working with many, many teachers, I often see teachers’ enthusiasm or dislike for a particular activity or content area transfer to their students.”

McLean and Jones, however, are careful to emphasize that supporting teacher well-being can’t just be up to the teachers. Assistant principals, principals and other educational leaders should prioritize teacher wellness across the school and district. If teachers’ negative emotions in the classroom result in part from challenging working conditions or insufficient resources, educational leaders and policymakers should consider system-wide changes and supports to foster teacher well-being. 

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Journal

Contemporary Educational Psychology

DOI

10.1016/j.cedpsych.2025.102352 

Method of Research

Observational study

Subject of Research

People

Article Title

Using an observational measure of elementary teachers’ emotional expressions during mathematics and English language arts to explore associations with students’ content area emotions and engagement

Article Publication Date

4-Mar-2025