National study of US emergency department visits for acute allergic reactions, 1993 to 2004

Gaeta, Theodore J.; Clark, Sunday; Pelletier, Andrea J.; Camargo, Carlos A.

doi:10.1016/s1081-1206(10)60883-6

Cited by 135 publications

(132 citation statements)

References 19 publications

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“…[3–6] Lack of a definition affects all components of care and likely accounts for the substantial diagnostic disparity observed in the “real world.”[13,15–17] It has been estimated that at least 50% of anaphylaxis episodes are misdiagnosed in the ED when the diagnostic criteria of current guidelines are not used. [19,20] More importantly for the patient, low recognition of anaphylaxis in the ED may delay the treatment with epinephrine and result in comorbidity, hospitalization and death. [17,18,21–25]…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…[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). [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%).…”

Section: Discussionmentioning

confidence: 99%

“…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). [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: 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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…A problematic issue with this definition, which may explain the under-reporting or misreporting of anaphylaxis cases, is the failure to agree among health care providers on the severity threshold for classifying a reaction as anaphylactic reaction. According to two important studies [7,8], only 1 % of the acute systemic allergic reactions evaluated in emergency departments had been diagnosed as anaphylaxis, as most of the systemic allergic reactions received a diagnosis of acute allergic or acute hypersensitivity reaction. In another study from hospital emergency departments in the United States, 57 % of very likely episodes of food anaphylaxis did not receive a diagnosis of anaphylaxis [9].…”

mentioning

confidence: 99%

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

et al. 2013

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There are wide differences in estimated incidence and prevalence of anaphylaxis because of the absence, until recently, of a universal consensus on the definition of anaphylaxis and the different source of collected data. We aimed to estimate the incidence of food anaphylaxis based on the database of Piemonte Region (Italy) Reference Center for Severe Allergic Reactions. All cases of severe food allergic reactions reported in 2010 were studied. Clinical data associated to the reports were evaluated according to National Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network diagnostic criteria of anaphylaxis. 75 % of the 778 cases were classified as food anaphylaxis (incidence of 13/100,000 personyears, ranging from 9.9 in adults to 29/100,000 person-years in children). Nuts were the most frequent foods causing anaphylaxis. Milk and eggs were responsible for anaphylaxis more often in children, while peach, vegetables and crustaceans were in adults. Cardiovascular symptoms were more frequent in adults. Gastrointestinal involvement was more frequent in children. A high prevalence of respiratory allergic comorbidities was observed. Food is an important cause of anaphylaxis, particularly in subjects with respiratory allergic comorbidities. Children and adults differ in triggers and clinical presentation of anaphylaxis.Keywords: Anaphylaxis, Food allergy, Epidemiology, Allergy Introduction Population-based studies estimate the incidence of anaphylaxis in western countries to be in the range of 4-50 per 100,000 person-years [1, 2], with a true lifetime prevalence in the range of 0.05-2 % [3]. Foods are reported to be the most important trigger of anaphylaxis, being responsible for 33.2-56 % of all anaphylaxis cases [4]. The other two principal triggers of anaphylaxis are insect stings and drugs [1,5]. The relative contribution of each of these triggers to anaphylaxis may differ according to the study design, study population, or geographic area. The wide differences in the estimated incidences and prevalences of anaphylaxis are the direct result of the absence, until recently, of a universal consensus on the definition of anaphylaxis and the different source of collected data. For this reason in 2005 the National Institute of Allergy and Infectious Disease (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) developed a very useful preliminary definition, based on diagnostic criteria [6]. The symposium defined anaphylaxis as: "a serious allergic reaction that is rapid in onset and may cause death". Clinically, involvement of at least two organs (skin or mucosal tissue, cardiovascular apparatus, breathing apparatus, gastrointestinal tract) is required, or a sudden reduced blood pressure along with a temporal relationship (generally minutes) to a potential causative agent. A problematic issue with this definition, which may explain the under-reporting or misreporting of anaphylaxis cases, is the failure to agree among health care providers on the severity threshold for classi...

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Glucocorticoids for the treatment of anaphylaxis

Choo

Simons

Sheikh

2009

Cochrane Database of Systematic Reviews

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National study of US emergency department visits for acute allergic reactions, 1993 to 2004

Cited by 135 publications

References 19 publications

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

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

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

Glucocorticoids for the treatment of anaphylaxis

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