Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital

Abstract

Background:To date, few studies have evaluated the degree of compliance with recommendations of anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines recommendations in an ED of a tertiary hospital. Methods: Medical records of patients that were assisted in the ED of the University Hospital of Salamanca (Spain) were reviewed. Those patients fulfilling anaphylaxis criteria proposed by the NIAID/FAAN were selected. Results: During one year period, we identified 89 patients, 74 adults and 15 children. In the 65% of adults the anaphylactic reaction was moderate, in 34% severe and in 1% very severe. In children, all reactions were moderate. Less than half (42%) of patients received adrenaline at ED, which was administered intramuscularly only in 19% of the cases. Regarding the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were no treated with adrenaline. At discharge from ED, an adrenaline auto-injector was recommended only to 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs. 27% children, p=0.047), 29% instructions about avoidance of triggers (31% adults vs. 20% children, n.s.), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs. 100% children, p<0.001). Conclusion: The results of the study show a large discrepancy between guidelines recommendations and anaphylaxis management in ED. Additional efforts in education to improve the treatment of patients with anaphylactic reactions are needed.

Anaphylaxis: A Decade of a Nationwide Allergy Society Registry

“…This study shows that anaphylaxisoccurs across all age groups. As observed in other case-series,a predominance of anaphylaxis was found in female gender in adults, whereas in children there was a male predominance [5,13,15,16,19,20].It has been suggested that endocrine factors might be involved in the pathogenesis of this disease, as with other immune-based diseases [5,19]. Food allergywas the main elicitor of anaphylaxis, as it has been described in several case-series, especially when children are included [8,11,13,15,16,[20][21][22][23].Shellfish and CM were the main culprits, in adults and in children, respectively.…”

“…As observed in other case-series,a predominance of anaphylaxis was found in female gender in adults, whereas in children there was a male predominance [5,13,15,16,19,20].It has been suggested that endocrine factors might be involved in the pathogenesis of this disease, as with other immune-based diseases [5,19]. Food allergywas the main elicitor of anaphylaxis, as it has been described in several case-series, especially when children are included [8,11,13,15,16,[20][21][22][23].Shellfish and CM were the main culprits, in adults and in children, respectively. CM was the leading cause in children, as reported by others [6,15,16,18,21],especially in the first years of life [6,15].These findingsdiverge from those of other authors [8,14,[23][24][25],underlining the importance of having a detailed knowledge of each country's reality.The observed frequency has variations, based on the studied age group, the geographical region and the associated food habits [6,13,14,24,26].Other main foods in this study were fresh fruits and TNs.…”

“…Anaphylaxis is a medical emergency requiring immediate treatment, and intramuscular adrenaline is the first-line drug treatment [1,3,4,23,47,48].However, although recommended by all guidelines, it continues to be underused at the ED. Less than half of our patients received adrenaline treatment, asreported by others [8,16,20,22,25,33,49].Therefore, improving medical education concerning anaphylaxis management in the EDis crucial.…”

Incorporation of a theme‐based research model into a pharmacy department research program

“…Proportionally fewer patients correctly received injectable promethazine and corticosteroids (oral or intravenous) and more patients with anaphylaxis received adrenaline and an adrenaline autoinjector on discharge. Where comparisons could be made, these results are better than those reported in recent studies …”

Impact of Specific Training in Anaphylaxis for Triage Nursing Staff in the Pediatric Emergency Department of a Tertiary Hospital

“…The plan includes the indication to attend the ED for follow-up or further treatment. Patients and caregivers do not always adhere to their plan [14][15][16]. Allergists are confident that patients with anaphylaxis are attended immediately in the ED.…”