Multicenter study of emergency department visits for insect sting allergies

Clark, Sunday; Long, Aidan A.; Gaeta, Theodore J.; Camargo, Carlos A.

doi:10.1016/j.jaci.2005.06.026

Cited by 159 publications

(124 citation statements)

References 29 publications

(33 reference statements)

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“…[8–10,27–13;29,31,33,34] Our data show a similar range. An overall rate of 11% has been reported using data from the US National Hospital Ambulatory Medical Care Survey (1993–2004)[20] and, separately, by the Florida Agency for Health Care Administration (2005–2006).…”

Section: Discussionsupporting

confidence: 72%

“…[19] The published data confirm the greater use of second-line agents than epinephrine in the treatment of anaphylaxis in the ED with approximately 80% of patients receiving antihistamines (range 51%–92%)[1,8–10,20,31–34] and 60%, corticosteroids (range 34%–89%). [1,8–10,31,33] While we did not specifically ask about these second-line agents, several respondents commented that antihistamines were a preferred first treatment for anaphylaxis in their ED.…”

Section: Discussionmentioning

confidence: 86%

“…However, we were able to find 13 US studies (8 in adults, 5 in adolescents and children) in which individual gaps in diagnosis, treatment, and follow-up could be inferred. [1,8–10,19,20,27–34] The applicable data are summarized in Table 2.…”

Section: Discussionmentioning

confidence: 99%

“…Studies also indicate discordance with guideline recommendations for discharge in the US: approximately 45% of patients treated for anaphylaxis in the ED received a discharge prescription for epinephrine (range 16%–63%);[8–10,27,29,31,33,34] and even fewer were given a referral to an allergist (21.6%, range 11%–33%)[8–10,27,29,33,34] and/or information about avoiding causative agents (23.5%, range 3%–40%). [9,10,33,34] Treatment with epinephrine in the ED may predict the likelihood of a prescription for epinephrine at discharge and referral to an allergist.…”

Section: Discussionmentioning

confidence: 99%

“…[9,10,33,34] Treatment with epinephrine in the ED may predict the likelihood of a prescription for epinephrine at discharge and referral to an allergist. [9,27,29] Anecdotally, our data agree.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

Russell

Farrar

Nowak

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers. The study aimed to evaluate how emergency departments (EDs) in the United States (US) manage anaphylaxis in relation to guideline recommendations.METHODS:This was an online anonymous survey of a random sample of EM health providers in US EDs.RESULTS:Data analysis included 207 EM providers. For respondent EDs, approximately 9% reported using agreed-upon clinical criteria to diagnose anaphylaxis; 42% reported administering epinephrine in the ED for most anaphylaxis episodes; and <50% provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge. Most provided some written materials, and follow-up with a primary care clinician was recommended.CONCLUSIONS:This is the first cross-sectional survey to provide “real-world” data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine. Prospective research is recommended.

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