Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature

Abstract

To cite this article: Kastner M, Harada L, Waserman S. Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature. Allergy 2010; 65: 435–444.AbstractDiagnosis and management of anaphylaxis can be a challenge because reactions are often unexpected and progress quickly. The focus of anaphylaxis management has mostly been on the acute episode, with little attention given to the long‐term management of patients at risk. This is compounded by conflicting information in current guidelines and a general lack of agreement among clinicians about which management strategies are the most appropriate. We systematically reviewed the literature to identify and summarize studies that investigated gaps in anaphylaxis management. Our search included MEDLINE, EMBASE, CINAHL, and Evidence‐Based Medicine Reviews. Studies were included if they addressed an outcome describing gaps in anaphylaxis knowledge, education, anaphylaxis management, and quality of life (QOL). Populations of interest were health care professionals involved in the care of patients at risk for anaphylaxis, and patients of any age, their parents, caregivers, and teachers in primary care, hospital or community settings. Of 5014 citations that were identified, the final 59 studies (selected from 75 full‐text articles) met the inclusion criteria. Two hundred and two gaps were identified and classified according to major themes: gaps in knowledge and anaphylaxis management (physicians and patients); gaps in follow‐up care (physicians); and QOL of patients and caregivers. Findings from this systematic review revealed gaps in anaphylaxis management at the level of physicians, patients, and the community. Findings will be used to provide a basis for developing interventional strategies to help address these deficiencies.

Anaphylaxis: Are doctors adequately aware? A study on perceptions and practices among first contact-level doctors in state healthcare institutions in Gampaha district

“…In a study conducted among emergency department staff in Singapore, more than 80% of respondents knew the correct dose and 14 A number of other studies from UK, USA, Canada, New Zealand, Australia, Germany and France showed deficiencies in awareness such as lack of knowledge on anaphylaxis and auto-injectors, sub-optimal use of adrenaline as the first-line drug and delayed administration. 13 However, the accuracy levels on correct dose and mode of administration are better in our study in comparison to an Indian study done among interns, medical students and nurses. 19 Another significant finding in our study was the unacceptably low level of awareness about the AAI.…”

“…Many countries have evaluated perceptions of physicians, other health care professionals, patients and the community in order to identify the gaps in anaphylaxis management 13 and have reported deficiencies in the knowledge and management.…”

School Board Policies on Prevention and Management of Anaphylaxis in İstanbul: Where Do We Stand?

“…These policies are based on the principles of food allergen avoidance, including the avoidance of food sharing and cross-contact, and preparedness with epinephrine. However, previous studies demonstrated that school personnel often lack the knowledge and skills necessary to recognize and treat anaphylactic reactions (12)(13)(14). Many schools did not provide their staff with education on how to prevent allergic reactions or respond to life-threatening events (4,15).…”

Exploring mHealth Participation for Emergency Response Communities

“…With the onset of anaphylaxis an immediate intramuscular (im) adrenaline injection is the first-line of treatment and can be lifesaving and it has been noted that there are no absolute contraindications to the prescription and utilization of self-injectable adrenaline (Song, Worm, & Lieberman, 2014 Adherence by chronic patients to medical regimens is recognized to be dismally low (Sabaté, 2003). With anaphylaxis in particular, it has been noted that many patients who have been prescribed epinephrine auto-injectors, because of a previous anaphylactic attack, do not carry them with studies showing that <30% of these patients carried it at all times (Johnson & Parker, 2006;Kastner, Harada, & Waserman, 2010;Song et al, 2014). There are few studies on anaphylaxis management in pre hospital settings.…”

“…Despite this, significant delay in epinephrine administration (i.e.,≥ 5 min) was also found to be an important gap in anaphylaxis management (Bilò et al, 2016;Kastner et al, 2010). The onset of anaphylaxis can be sudden however it is generally recognized (Song et al, 2014) that there is sufficient time and awareness on the part of the patient to initiate use of an epinephrine auto-injector should one be available.…”