Anaphylaxis Attended in Emergency Departments: a Reliable Picture of Real-world Anaphylaxis

Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes

“… 39 , 40 The decision of whether to prescribe EAI in EDs may be confounded by the difficulties prescribers face in determining whether patients have indeed had anaphylaxis. 41 , 42 In such cases, it might be preferable for ED prescribers to defer the decision until a formal allergy review; however, data from retrospective studies indicate that only a minority of patients are referred to allergists on ED discharge. 36 , 43 This is also of concern when considering patients treated in the ED for nonanaphylaxis reactions who arguably meet guidelines for EAI prescription.…”

“…Compared with ED providers, allergists are better prepared to accurately diagnose allergic diseases and determine which patients are most likely to benefit from epinephrine. Although anaphylaxis is underdiagnosed in the ED, 41 many patients who receive an initial ED diagnosis of a suspected allergic reaction or anaphylaxis are later found not to have had an allergic reaction. This is supported by a 2019 study in which only half of 582 patients treated for an allergic reaction in ED were actually considered to have had an allergic reaction at subsequent allergist follow-up.…”