Anaphylaxis definition, overview, and clinical support tool: 2024 consensus report-a GA²LEN project

Collaborators, Affiliations

Collaborators

GA(2)LEN Anaphylaxis Study Team:
Montserrat Alvaro-Lozano¹², Stefania Arasi¹³, Moshe Ben-Shoshan¹⁴, Kirsten Beyer¹⁵, Dianne E Campbell¹⁶, Ronna L Campbell¹⁷, Victoria Cardona¹⁸, R Sharon Chinthrajah¹⁹, Antoine Deschildre²⁰, Motohiro Ebisawa²¹, Montserrat Fernandez-Rivas²², Alessandro Fiocchi²³, David M Fleischer²⁴, Adam T Fox²⁵, Katie Frith²⁶, Lene H Garvey²⁷, R Maximiliano Gómez²⁸, Matthew Greenhawt²⁴, Ruchi Gupta²⁹, Douglas P Mack³⁰, Kenneth A Michelson³¹, Caroline Nilsson³², Anna Nowak-Wegrzyn³³, Hanneke N G Oude Elberink³⁴, Ruby Pawankar³⁵, Guillaume Pouessel²⁰, Pablo Rodriguez Del Rio³⁶, Nicholas Henry Sargant³⁷, Amy M Scurlock³⁸, Marcus S Shaker³⁹, Peter Smith⁴⁰, Jasmeet Soar⁴¹, Brad Sobolewski⁴², Luciana Kase Tanno⁴³, Gary Wing-Kin Wong⁴⁴

Affiliations

¹ Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: Timothy.Dribin@cchmc.org.
² Department of Woman and Child Health, Food Allergy Centre, Padua University Hospital, Padua, Italy.
³ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
⁴ National Heart & Lung Institute, Imperial College London, London, United Kingdom.
⁵ Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
⁶ University of Southampton Faculty of Medicine, David Hide Asthma and Allergy Centre, Southampton, United Kingdom; St Mary's Hospital, Newport, United Kingdom; National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
⁷ Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Tex; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Tex.
⁸ Hans Christian Andersen Children's Hospital, Odense, Denmark; Denmark University of Southern Denmark, Odense, Denmark.
⁹ The University of Tennessee Health Science Center, Memphis, Tenn.
¹⁰ Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charite Univeritätsmedizin Berlin, Berlin, Germany.
¹¹ Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany; Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany.
¹² Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
¹³ Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, Rome, Italy.
¹⁴ Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
¹⁵ Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁶ Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁷ Department of Emergency Medicine, Mayo Clinic, Rochester, Minn.
¹⁸ Department of Allergy, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
¹⁹ Sean N Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif.
²⁰ CHU Lille, University of Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France.
²¹ Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan.
²² Allergy Department, Hospital Clinico San Carlos, Facultad de Medicina, Universidad Complutense, IdISSC, Madrid, Spain.
²³ Pediatric Hospital Bambino Gesù IRCCS, Rome, Italy.
²⁴ University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo.
²⁵ Guy's & St Thomas' Hospitals NHS Foundation Trust, London, England, United Kingdom.
²⁶ Department of Immunology, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
²⁷ Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
²⁸ Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina.
²⁹ Center for Food Allergy & Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ull.
³⁰ Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
³¹ Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
³² Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
³³ New York University Grossman School of Medicine, New York, NY.
³⁴ Department of Allergology, Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Groningen Research Institute of Asthma and COPD, University of Groningen, Groningen, The Netherlands.
³⁵ Department of Pediatrics, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo, Japan.
³⁶ Servicio de Alergia, Hospital Universitario Niño Jesús, Madrid, Spain.
³⁷ Bristol Royal Hospital for Children, Bristol, England, United Kingdom.
³⁸ University of Arkansas for Medical Sciences Arkansas Children's Hospital and Research Institute, Little Rock, Ark.
³⁹ Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth-Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, NH.
⁴⁰ Clinical Medicine, Griffith University, Southport, Queensland, Australia; Queensland Allergy Services Private Practice, Queensland, Southport, Australia.
⁴¹ Southmead Hospital, North Bristol NHS Trust, Bristol, England, United Kingdom.
⁴² Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
⁴³ Division of Allergy, University of Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France; Montpellier WHO Collaborating Centre on Scientific Support of Classifications, Montpellier, France.
⁴⁴ Department of Paediatrics, Chinese University of Hong Kong, Hong Kong.

PMID: 39880313
PMCID: PMC12301991 (available on 2026-01-27)
DOI: 10.1016/j.jaci.2025.01.021

Anaphylaxis definition, overview, and clinical support tool: 2024 consensus report-a GA²LEN project

Timothy E Dribin et al. J Allergy Clin Immunol. 2025 Aug.

. 2025 Aug;156(2):406-417.e6.

doi: 10.1016/j.jaci.2025.01.021. Epub 2025 Jan 27.

Collaborators

GA(2)LEN Anaphylaxis Study Team:
Montserrat Alvaro-Lozano¹², Stefania Arasi¹³, Moshe Ben-Shoshan¹⁴, Kirsten Beyer¹⁵, Dianne E Campbell¹⁶, Ronna L Campbell¹⁷, Victoria Cardona¹⁸, R Sharon Chinthrajah¹⁹, Antoine Deschildre²⁰, Motohiro Ebisawa²¹, Montserrat Fernandez-Rivas²², Alessandro Fiocchi²³, David M Fleischer²⁴, Adam T Fox²⁵, Katie Frith²⁶, Lene H Garvey²⁷, R Maximiliano Gómez²⁸, Matthew Greenhawt²⁴, Ruchi Gupta²⁹, Douglas P Mack³⁰, Kenneth A Michelson³¹, Caroline Nilsson³², Anna Nowak-Wegrzyn³³, Hanneke N G Oude Elberink³⁴, Ruby Pawankar³⁵, Guillaume Pouessel²⁰, Pablo Rodriguez Del Rio³⁶, Nicholas Henry Sargant³⁷, Amy M Scurlock³⁸, Marcus S Shaker³⁹, Peter Smith⁴⁰, Jasmeet Soar⁴¹, Brad Sobolewski⁴², Luciana Kase Tanno⁴³, Gary Wing-Kin Wong⁴⁴

Affiliations

¹ Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: Timothy.Dribin@cchmc.org.
² Department of Woman and Child Health, Food Allergy Centre, Padua University Hospital, Padua, Italy.
³ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
⁴ National Heart & Lung Institute, Imperial College London, London, United Kingdom.
⁵ Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
⁶ University of Southampton Faculty of Medicine, David Hide Asthma and Allergy Centre, Southampton, United Kingdom; St Mary's Hospital, Newport, United Kingdom; National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
⁷ Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Tex; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Tex.
⁸ Hans Christian Andersen Children's Hospital, Odense, Denmark; Denmark University of Southern Denmark, Odense, Denmark.
⁹ The University of Tennessee Health Science Center, Memphis, Tenn.
¹⁰ Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charite Univeritätsmedizin Berlin, Berlin, Germany.
¹¹ Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany; Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany.
¹² Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
¹³ Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, Rome, Italy.
¹⁴ Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
¹⁵ Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁶ Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁷ Department of Emergency Medicine, Mayo Clinic, Rochester, Minn.
¹⁸ Department of Allergy, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
¹⁹ Sean N Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif.
²⁰ CHU Lille, University of Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France.
²¹ Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan.
²² Allergy Department, Hospital Clinico San Carlos, Facultad de Medicina, Universidad Complutense, IdISSC, Madrid, Spain.
²³ Pediatric Hospital Bambino Gesù IRCCS, Rome, Italy.
²⁴ University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo.
²⁵ Guy's & St Thomas' Hospitals NHS Foundation Trust, London, England, United Kingdom.
²⁶ Department of Immunology, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
²⁷ Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
²⁸ Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina.
²⁹ Center for Food Allergy & Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ull.
³⁰ Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
³¹ Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
³² Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
³³ New York University Grossman School of Medicine, New York, NY.
³⁴ Department of Allergology, Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Groningen Research Institute of Asthma and COPD, University of Groningen, Groningen, The Netherlands.
³⁵ Department of Pediatrics, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo, Japan.
³⁶ Servicio de Alergia, Hospital Universitario Niño Jesús, Madrid, Spain.
³⁷ Bristol Royal Hospital for Children, Bristol, England, United Kingdom.
³⁸ University of Arkansas for Medical Sciences Arkansas Children's Hospital and Research Institute, Little Rock, Ark.
³⁹ Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth-Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, NH.
⁴⁰ Clinical Medicine, Griffith University, Southport, Queensland, Australia; Queensland Allergy Services Private Practice, Queensland, Southport, Australia.
⁴¹ Southmead Hospital, North Bristol NHS Trust, Bristol, England, United Kingdom.
⁴² Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
⁴³ Division of Allergy, University of Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France; Montpellier WHO Collaborating Centre on Scientific Support of Classifications, Montpellier, France.
⁴⁴ Department of Paediatrics, Chinese University of Hong Kong, Hong Kong.

PMID: 39880313
PMCID: PMC12301991 (available on 2026-01-27)
DOI: 10.1016/j.jaci.2025.01.021

Abstract

Background: The 2006 National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network anaphylaxis criteria are widely used in clinical care and research. In 2020, the World Allergy Organization published modified criteria that have not been uniformly adopted. Different criteria contribute to inconsistent care and research outcomes.

Objective: We sought to develop a consensus anaphylaxis definition, overview, and clinical support tool.

Methods: A 12-member writing group developed draft outputs modified with input from a 46-member international expert panel, 31 medical stakeholder organizations, and 15 patient advocacy organizations. The expert panel participated in a modified Delphi process to seek consensus for the outputs using a ≥80% consensus threshold.

Results: The first sentence of the definition reads, "Anaphylaxis is a serious allergic (hypersensitivity) reaction that can progress rapidly and may cause death." The definition also describes organ systems that may be involved and signs of life-threatening reactions. The overview includes details of anaphylaxis recognition and management. The clinical support tool incorporates new clinical criteria to help determine the likelihood that patients are having anaphylaxis, intramuscular epinephrine indications and dosing, and common findings from the anaphylaxis organ systems. In addition, 93.5% (43/46), 97.8% (45/46), and 93.5% (43/46) of experts agreed with the definition, overview, and clinical support tool, respectively.

Conclusion: The anaphylaxis overview is a novel educational tool conveying key elements of anaphylaxis recognition and management. We propose that the definition and clinical support tool should replace previous definitions and clinical criteria. The clinical support tool should facilitate improved anaphylaxis recognition and management across different clinical settings and standardize research outcomes.

Keywords: Adrenaline; anaphylaxis; clinical criteria; definition; epinephrine.

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Conflict of interest statement

Disclosure statement Supported by the Global Allergy and Asthma Excellence Network, GA(2)LEN Anaphylaxis Core, Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center; the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH) under award K23AI175525; the National Center for Advancing Translational Sciences, NIH, under award 2UL1TR001425-05A1; and the National Center for Advancing Translational Sciences, NIH, under award 2KL2TR001426-05A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Disclosure of potential conflict of interest: T. E. Dribin reports grant support from the National Institutes of Health, Cincinnati Children’s Hospital Research Foundation, and the Center for Clinical & Translational Science & Training. A. Muraro reports speaker fees for Aimmune, Nestlé Health Science, Nestlé Purina, DVB Technologies, and Sanofi; and advisory boards for Sanofi, DVB Technologies, Nestlé Health Science, Novartis, and Regeneron. C. A. Camargo Jr has served on the scientific advisory boards of ARS Pharma, Aquestive, and Bryn. P. J. Turner reports service as chairperson for the World Allergy Organization (WAO) Anaphylaxis Committee and colead for the Resuscitation Council UK Anaphylaxis Guideline Group. J. Wang reports institutional clinical trial support from the NIH, Aimmune, DBV Technologies, and Siolta; consulting fees from DBV Technologies and Novartis; and royalties from UpToDate. G. Roberts is author of the EAACI Anaphylaxis Guidelines and president of the British Society for Allergy and Clinical Immunology. A. Anagnostou reports institutional funding from Novartis; advisory board member for Ready, Set, Food, Novartis, Genentech, and Bryn; and consultation/speaker fees from ALK, EPG Health, MJH, Adelphi, Aimmune Therapeutics, Genentech, FARE, Medscape, and Innovation Horizons. S. Halken reports personal speaker fees from ALK Nordic, Viatris, Meadjohnson Europe, and Abigo; and personal fee from Stallergenes for being a member of IDMC for an allergen immunotherapy trial during the conduct of the study. J. Liebermann reports institutional funding from DBV and Novartis; advisor/consultant for ALK, Aquestive, ARS, Bryn, Genentech, Novartis Adjudication, AbbVie, Amgen, and Celldex; cochairship of Joint Task Force for Practice Parameters; and board member of the American Board of Allergy and Immunology. M. Worm reports honoraria and/or consulting fees from AbbVie, Aimmune Therapeutics, ALK-Abelló, Allergopharma, Almirall, Amgen, Biotest, Boehringer Ingelheim, DBV Technologies, Genzyme, Kymab, LEO Pharma, Eli Lilly, Mylan, Novartis, Pfizer, Regeneron Pharmaceuticals, Sanofi, Stallergenes Greer, and Worg Pharmaceutics. T. Zuberbier reports institutional funding for research, lecture honoria, and/or consulting from Amgen, AstraZeneca, AbbVie, ALK, Almirall, Astellas, Bayer Health Care, Bencard, Berlin Chemie, FAES, HAL, Henkel, Kryolan, Leti, L’Oreal, Meda, Menarini, Merck, MSD, Novartis, Pfizer, Sanofi, Stallergenes, Takeda, Teva, UCB, and Uriach; and is a member of Allergic Rhinitis and Its Impact on Asthma (ARIA)/World Health Organization, German Society for Allergology and Clinical Immunology, European Centre for Allergy Research Foundation, GA(2)LEN, and WAO. H. A. Sampson reports funding to his institution for grants from the NIAID, NIH; consulting fees from DBV Technologies, N-Fold Therapeutics, and Siolta; and stock options from DBV Technologies and N-Fold Therapeutics.

References

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Anaphylaxis definition, overview, and clinical support tool: 2024 consensus report-a GA²LEN project

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Anaphylaxis definition, overview, and clinical support tool: 2024 consensus report-a GA²LEN project

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