Epinephrine use and outcomes in anaphylaxis patients transported by emergency medical services

Manivannan, Veena; Hyde, Robert J.; Hankins, Daniel; Bellolio, M. Fernanda; Fedko, Martin G.; Decker, Wyatt W.; Campbell, Ronna L.

doi:10.1016/j.ajem.2014.05.014

Cited by 19 publications

(10 citation statements)

References 21 publications

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“…In line with previous studies of anaphylaxis at pre-hospital level [16, 27, 28] and in the emergency room [11], our study shows that adrenaline was administered in only 54% of patients with moderate to severe anaphylaxis whereas antihistamines and glucocorticoids were administrated in nearly all cases. Not all symptoms in Sampson’s severity score grade 3 require treatment with adrenaline.…”

Section: Discussionsupporting

confidence: 91%

Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study

Oropeza

Mikkelsen

Bindslev‐Jensen

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundBee and wasp stings are among the most common triggers of anaphylaxis in adults representing around 20% of fatal anaphylaxis from any cause. Data of pre-hospital treatment of bee and wasp induced anaphylactic reactions are sparse. This study aimed to estimate the incidence of bee and wasp induced anaphylactic reactions, the severity of the reactions and to correlate the pre-hospital treatment with the severity of the anaphylactic reaction.MethodsRetrospective and descriptive study based on data from the Mobile Emergency Care Units (MECUs) in the Region of Southern Denmark (2008 only for Odense and 2009–2014 for the whole region). Discharge summaries with diagnosis related to anaphylaxis according to the International Classification of Diseases 10 (ICD-10) were reviewed to identify bee and wasp induced anaphylactic reactions. The severity of the anaphylactic reaction was assessed according to Sampson’s severity score and Mueller’s severity score. Treatment was evaluated in relation to administration of adrenaline, glucocorticoids and antihistamine.ResultsWe identified 273 cases (Odense 2008 n = 14 and Region of Southern Denmark 2009–2014 n = 259) of bee and wasp induced anaphylaxis. The Incidence Rate was estimated to 35.8 cases per 1,000,000 person year (95% CI 25.9–48.2) in the Region of Southern Denmark during 2009–2014. According to Sampson’s severity score, 65% (n = 177) of the cases were graded as moderate to severe anaphylaxis (grade 3–5). Almost one third of cases could not be graded according to Mueller’s severity score. Adrenaline was administrated in 54% (96/177) of cases with moderate to severe anaphylaxis according to Sampson’s severity score, compared to 88% receiving intravenous glucocorticoids (p < 0.001) and 91% receiving intravenous antihistamines (p < 0.001). Even in severe anaphylaxis (grade 5) adrenaline was administered in only 80% of the cases.ConclusionTreatment with adrenaline is not administered in accordance with international guidelines. However, making an assessment of the severity of the anaphylactic reaction is difficult in retrospective studies.

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Section: Discussionsupporting

confidence: 91%

Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study

Oropeza

Mikkelsen

Bindslev‐Jensen

et al. 2017

Scand J Trauma Resusc Emerg Med

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“…performed a web‐based survey of 6019 schools that participated in the EpiPen4Schools program and found that out of nearly 1000 events, approximately 25% of individuals with anaphylactic events were not treated with EAIs. Manivannan et al . analyzed use of epinephrine by emergency medical services (EMS) transport personnel and found that it was used in less than 20% of cases of suspected allergic reactions, although not all these patients displayed signs of full anaphylaxis.…”

Section: Pitfalls In the Administration Of Epinephrinementioning

confidence: 99%

Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement

Cohen

Saunders

Wise

et al. 2016

Int Forum Allergy Rhinol

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Epinephrine is a potent medication with lifesaving indications and is the standard of care for treatment of anaphylaxis. The delivery of epinephrine in both trained and untrained populations carries certain pitfalls and complications that can have serious consequences. Identification of the scope of the problem is an important step in improving education for both providers and patients who are tasked with use of epinephrine for allergy emergencies.

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“…The administration of adrenaline by the EMS was associated with venom triggers, the presence of respiratory symptoms and fulfillment of anaphylaxis diagnostic criteria [38].…”

Section: Current Evidencementioning

confidence: 99%

Adrenaline in anaphylaxis treatment. Balancing benefits and harms

Cervellin

Sanchís-Gomar

Lippi

2016

Expert Opinion on Drug Safety

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Due to the lack of solid evidence supporting the use of adrenaline in patients with anaphylaxis, except in severe cases, the strength of recommendations should be readdressed, limiting administration to selected categories of patients. Caregivers should promptly act in pre-hospital setting, given the shortness of time and lack of technology. In the hospital setting, and more specifically in the ED, clinicians should consider the prompt use of adrenaline in severe anaphylaxis cases, but they should also be able to judiciously wait in the vast majority of milder anaphylactic reactions, which may resolve spontaneously.

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Epinephrine use and outcomes in anaphylaxis patients transported by emergency medical services

Cited by 19 publications

References 21 publications

Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study

Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study

Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement

Adrenaline in anaphylaxis treatment. Balancing benefits and harms

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