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15?mg dose for children weighing between 10 and 25?kg (22�C55?lb) and a 0.3?mg dose for children weighing ��25?kg (��55?lb) (82). However, as Sicherer et?al. (79) point out, providing the appropriate dose for children who fall below the lowest weight parameter (15?kg) can be difficult and can lead to overdosing (with the 0.15?mg dose in infants who weigh [http://en.wikipedia.org/wiki/INPP5D INPP5D] is that it was not possible to combine the results in a meta-analysis because the studies were too heterogeneous to pool. However, [http://www.selleckchem.com/products/azd4547.html learn more] we addressed potential sources of variability between relevant studies (in addition to random error) by the rigorous study quality assessment and critical appraisal of studies, as well as the differences between studies for populations, settings, and outcomes. Another possible limitation of our study is that we did not limit our search to study designs with the best quality of evidence such as RCTs. However, our objective was to identify gaps in anaphylaxis management, which can be addressed in prospective, retrospective, or qualitative studies, but most appropriately in epidemiologic evaluations that assess [http://www.selleckchem.com/products/Cisplatin.html Cisplatin mw] risk factors and long-term rare outcomes such as in cross-sectional and cohort studies. In fact, prospective, placebo-controlled trials in anaphylaxis research are largely lacking because they are difficult to conduct and unethical in most cases. This is evidenced by a recent systematic review that attempted to assess the benefits and harms of adrenaline in the emergency treatment of anaphylaxis, but failed to retrieve any randomized or quasi-randomized trials (78). Controlled studies are also difficult to conduct because anaphylactic reactions are relatively uncommon or under recognized, are unpredictable, and can occur in health care settings even if preventive efforts are established (82). Furthermore, there is great variability among patients for the clinical presentation of anaphylaxis. Patients vary in the onset of symptoms after exposure (from minutes to hours), the number and severity of symptoms (from mild to fatal within minutes) (83), and the exposure may be fatal even if optimal treatment is provided immediately (1). Lastly, the included studies that were captured by our systematic review are most representative of anaphylaxis from food allergy in mostly pediatric patients.