Adrenaline in anaphylaxis treatment and self-administration: experience from an inner city emergency department

Abstract

The majority of patients were treated according to the EAACI guidelines for management of anaphylaxis, but only a minority received the recommended adrenaline auto-injector for self-administration at discharge. Because the majority of patients received medical help later than 30 min after symptom onset, adrenaline auto-injector prescription is a necessity. The low rate of doctors prescribing adrenaline auto-injectors in the ED setting underlines the need to train doctors of various backgrounds in prevention and treatment of anaphylaxis and the close collaboration with allergologists.

Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis

“…Futhermore, initial suspected culprits are often not confirmed on subsequent allergy testing, which suggests caution in presumption of potential triggers and supports the necessity of follow-up evaluation by an allergy specialist. 47,73,74 With respect to treatment, delayed use of epinephrine has been associated with increased risk for fatality, and several observational studies and case reports series 48,[75][76][77][78][79][80][81][82][83][84][85][86][87][88] suggest a continued disparity between the diagnosis of anaphylaxis and frequency of appropriate epinephrine treatment. In 1 study 76 of drug-induced anaphylaxis evaluated and managed in an ED, only 8% of patients received epinephrine.…”

New trends in anaphylaxis

“…A variety of autoinjectors are available in Europe and North America. However, numerous studies have shown that, in reality, adrenaline autoinjectors are only rarely used [ 19 ]; moreover, even in emergency departments, they are not always prescribed following an anaphylactic reaction [ 20 ]. Experience gained from various training concepts suggest that it is possible to improve the use of adrenaline in the emergency setting.…”

First Results of Assessing the Quality of Medical Care at Pre-Hospital and Hospital Stages for Children with Acute Allergic Pathology

“…В исследовании, проведенном в 2017 г. Y. Mostmans и соавт., опубликованы результаты бельгийского пяти-летнего анализа соответствия оказанной СМП рекомен-дациям Европейской академии аллергии и клинической иммунологии (European Academy of Allergy and Clinical Immunology, EAACI) пациентам старше 18 лет с ана-филаксией [27]. Первую медицинскую помощь спустя 30 мин от начала симптомов получили 64% пациентов.…”

“…Полученные результаты свиде-тельствуют, что большинству пациентов оказывалась медицинская помощь в соответствии с рекомендациями EAACI для лечения анафилаксии. Тем не менее выявлен низкий процент назначения автоинжекторов с эпинеф-рином в амбулаторных условиях [27].…”