Addressing barriers to emergency anaphylaxis care: from emergency medical services to emergency department to outpatient follow-up

Fineman, Stanley; Bowman, Steven H.; Campbell, Ronna L.; Dowling, Paul; O'Rourke, Dianne; Russell, W. Scott; Sublett, J. Wesley; Wallace, Dana

doi:10.1016/j.anai.2015.07.008

Cited by 21 publications

(16 citation statements)

References 47 publications

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“…9,31 This difference might reflect the passive reporting nature of VAERS but might also reflect a diverse range of symptom severity, with some persons experiencing symptoms mild enough to be managed with other medications (eg, steroids and antihistamines) despite epinephrine's status as a first-line treatment for anaphylaxis. 9,32 These observations underscore current recommendations that any provider administering vaccines should have emergency protocols and supplies on hand, including epinephrine, should a patient develop anaphylaxis. 33 Vaccines for which anaphylaxis was reported reflected the recommended vaccine schedule for persons of the patient's age (Tables IV and V).…”

Section: Discussionmentioning

confidence: 74%

Anaphylaxis after vaccination reported to the Vaccine Adverse Event Reporting System, 1990-2016

Moro

et al. 2019

Journal of Allergy and Clinical Immunology

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Background: Anaphylaxis, a rare and potentially life-threatening hypersensitivity reaction, can occur after vaccination. Objective: We sought to describe reports of anaphylaxis after vaccination made to the Vaccine Adverse Event Reporting System (VAERS) during 1990-2016. Methods: We identified domestic reports of anaphylaxis within VAERS using a combination of Medical Dictionary for Regulatory Activity queries and Preferred Terms. We performed a descriptive analysis, including history of hypersensitivity (anaphylaxis, respiratory allergies, and drug allergies) and vaccines given. We reviewed all serious reports and all nonserious reports with available medical records to determine if they met the Brighton Collaboration case definition for anaphylaxis or received a physician's diagnosis. Results: During the analytic period, VAERS received 467,960 total reports; 828 met the Brighton Collaboration case definition or received a physician's diagnosis of anaphylaxis: 654 (79%) were classified as serious, and 669 (81%) had medical records available. Of 478 reports in children aged less than 19 years, 65% were male; childhood vaccines were most commonly reported. Of 350 reports in persons aged 19 years or greater, 80% were female, and influenza vaccines were most frequently reported. Overall, 41% of reports described persons with no history of hypersensitivity. We identified 8 deaths, 4 among persons with no history of hypersensitivity. Conclusion: Anaphylaxis after vaccination is rare in the United States and can occur among persons with no history of hypersensitivity. Most persons recover fully with treatment, but

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Section: Discussionmentioning

confidence: 74%

Anaphylaxis after vaccination reported to the Vaccine Adverse Event Reporting System, 1990-2016

Moro

et al. 2019

Journal of Allergy and Clinical Immunology

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“…Qualitative finding created by specialists of the American Academy of Allergy, Asthma & Immunology (AAAAI), discussed the current knowledge regarding anaphylaxis and they have highlighted three negative points in care in this clinical picture: (1) complexity of diagnosis, (2) prescription of adrenaline auto-injector (3) inadequate follow-up. ( 17 ) The content analysis of quantitative studies pointed out the main questions raised by authors, such as: (1) pharmacological treatment of anaphylaxis emergency, (2) prescription of adrenaline auto-injector, (3) knowledge of main signs and symptoms and (4) observation of patient after resolution of the anaphylactic picture.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of anaphylaxis: there is an urgent needs to implement the use of guidelines

Ribeiro

Chong-Neto

Filho

2017

Einstein (São Paulo)

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Anaphylaxis is a severe, life-threatening generalized or systemic hypersensitivity reaction that requires rapid and adequate care. This study aimed to obtain an integrated view of the level of physicians' knowledge related with treatment of anaphylaxis in studies published within the last 5 years. Sixteen studies were found and four points were identified as of the great interest to the authors: (1) emergency pharmacological treatment, (2) epinephrine auto-injectors prescription, (3) knowledge of the main signs of anaphylaxis, and (4) admission of the patient to verify biphasic reactions. Concern about the use of intramuscular adrenaline as the first choice in relation with anaphylaxis was evident in most studies, rather than its use in the comparison dial, and especially low in a study that included data from Brazil, in which the frequency of its use was 23.8%. An adrenaline autoinjector is highly recommended among specialists for patients at risk of anaphylaxis, however, its use is still infrequent among non-specialists and in countries that this agent is not available. Intervention studies have shown improved medical knowledge of anaphylaxis following disclosure of the information contained in the international guidelines. The analysis of these studies reinforces the need to disseminate international guidelines for diagnosis and treatment of anaphylaxis, as well as providing an adrenaline autoinjector, to improve management and to prevent a fatal outcome.

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“…26 The low positive predictive value (68%) of these criteria makes it a challenge for ED providers given the need to have a broad differential diagnosis. 27 In addition, physicians may not be aware of the proper way to administer epinephrine, which appears to affect patients' improper use as well. 28,29 In our study, physicians were much more likely to administer corticosteroids instead (33.8%), whether orally or via the parenteral route during anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

Recurrent anaphylaxis in the United States: time of onset and risk factors

Chaaban

Stuart

Watley

et al. 2019

Int Forum Allergy Rhinol

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Background Studies have not yet examined the trends and risk factors of biphasic and recurrent anaphylaxis in the United States using International Classification of Diseases, tenth revision (ICD‐10) CM codes. The goal of this study is to examine the trends of biphasic and recurrent anaphylaxis in all patient care settings (inpatient, outpatient, emergency department, and observation). Methods We used the Clinformatics database from 2015 to 2017. Our main outcome measure was recurrent anaphylactic events occurring within 1 year after the initial event. We used Cox proportional hazards modeling to assess the factors associated with recurrent anaphylaxis and the Kaplan‐Meier method to estimate time to recurrence. Results There were a total of 19,039 patients with incident anaphylaxis in 2016 and, of these, 2017 had a recurrent anaphylaxis event in the 12‐month period after the index date (10.6%). The most common trigger for recurrent anaphylaxis is venom followed by food allergens. Pediatric patients aged <18 years were more likely to develop recurrent anaphylaxis compared with patients aged 18 to 64 years (hazard ratio [HR], 1.53). Patients with allergic rhinitis and asthma were more likely to develop recurrent anaphylaxis compared to those without these comorbidities (HR, 1.15 and 1.27, respectively). Conclusion This is the first national study using ICD‐10 CM codes looking at rates of biphasic and recurrent anaphylaxis in all patient care settings. Recurrent anaphylaxis is more common in the first 3 days after the initial event, in younger patients (<18 years), and in patients with allergic rhinitis and/or asthma. Physicians need to prescribe epinephrine auto‐injectors and educate their patients about the risk of recurrence.

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Addressing barriers to emergency anaphylaxis care: from emergency medical services to emergency department to outpatient follow-up

Cited by 21 publications

References 47 publications

Anaphylaxis after vaccination reported to the Vaccine Adverse Event Reporting System, 1990-2016

Anaphylaxis after vaccination reported to the Vaccine Adverse Event Reporting System, 1990-2016

Diagnosis and treatment of anaphylaxis: there is an urgent needs to implement the use of guidelines

Recurrent anaphylaxis in the United States: time of onset and risk factors

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