The Role of Nurses in the Management of Anaphylaxis: A Systematic Review

Abstract

Context: Anaphylaxis is a life-threatening allergic emergency requiring rapid detection and intervention. Objectives: This systematic review aimed to review the evidence on the roles of nurses in its recognition, management, and prevention across diverse healthcare settings. Methods: This systematic review was conducted in accordance with the PRISMA 2020 statement. A comprehensive search was undertaken in PubMed, Scopus, Web of Science, and Science Direct from database inception to 30 July 2025 using MeSH and free-text terms for keywords such as "nurse," "anaphylaxis," and "management". Two reviewers independently screened records and extracted data using a standardized form; disagreements were resolved by a third reviewer. Quality was ascertained using RoB 2, ROBINS-I, and CASP. Synthesis without meta-analysis was performed owing to study heterogeneity; the findings were thematically categorized into clinical, educational, and systemic domains. Primary outcomes included clinical (timely epinephrine administration, patient stabilization), educational (staff competency), and systemic (protocol development). Results: From 1,068 records, 11 studies were included [10 studies: high/upper-middle-income, 1 study: Low- and middle-income countries (LMICs)], all demonstrating moderate-to-high quality. In the clinical domain, intramuscular epinephrine was administered in 73% of studies. In the educational domain, nurse-led training improved staff confidence in 71% of studies. In the systemic domain, protocol development occurred in 67% of studies. Triage training lowered prioritization errors by 25%. In Lebanon, 40% of nurses misused antihistamines. Simulation was effective but underused in LMICs. Conclusions: Nurses play critical roles in anaphylaxis recognition, management, and prevention, primarily evidenced in high-income settings. Evidence from LMICs is scarce (one study only), limiting generalizability. Simulation-based training and adapted protocols show promise, but further context-specific research in resource-limited settings is essential to optimize outcomes.