Physicians’ knowledge regarding epinephrine underuse in anaphylaxis

Abstract

Background: Anaphylaxis is a life-threating hypersensitivity reaction. Epinephrine underuse in patients with anaphylaxis could lead to poor outcomes. There is evidence that the epinephrine use in such patients could be as low as 8%. Objective: To assess the percentage of physicians who know that epinephrine is the first-line treatment in anaphylaxis. The secondary objective was to assess knowledge gaps regarding anaphylaxis diagnosis and treatment that could lead to epinephrine underuse. Methods: We performed an online survey for physicians in Mexico City, using a 10-item questionnaire assessing anaphylaxis knowledge. We obtained measures of central tendency for statistical analysis, such as frequency, 95% confidence interval, as well as the chi-square test for comparing the groups. Results: A total of 196 surveys were considered for analysis. Of all the participants, 96.44% were able to correctly diagnose an anaphylaxis case with cutaneous, respiratory, and cardiovascular symptoms. Fifty-two percent correctly diagnosed anaphylaxis without cutaneous symptoms. The 72.4% of the respondents chose epinephrine as the first-line treatment, 42.3% correctly answered that there is no absolute contraindication to giving epinephrine, and 20.9% ignored whether there was any contraindication for its use. Only 38.3% of participants answered that during discharge they would prescribe an autoinjector. Regarding the administration route, 63.4% answered that the first dose of epinephrine is applied intramuscularly and 50% of the participants chose the correct dose of epinephrine. Only 2.6% of the participants answered all 10 questions correctly. Conclusion: There is still some difficulty recognizing anaphylaxis without cutaneous symptoms. Even though two-thirds of physicians identified that epinephrine is the treatment of choice, only 49.5% would have used intramuscular epinephrine as first-line treatment. We found a low percentage of epinephrine ampule prescription and knowledge of the correct dose. These findings can account for epinephrine underuse when dealing with anaphylaxis in the real clinical practice.

Level of knowledge among healthcare professionals regarding anaphylaxis

“…Our study, including healthcare professionals from different healthcare institutions, showed that there was a lack of knowledge among healthcare professionals regarding the acute treatment of anaphylaxis such as the dose of epinephrine, and long-term therapy such as EAI doses, and prescribing rates. This lack of knowledge was similar to previous studies conducted in Turkey and different countries [ 16 17 18 19 20 ].…”

Knowledge of healthcare providers in the management of anaphylaxis

“…Pimental et al 20 reported 196 specialist physicians: pediatrics, internal medicine, cardiology, anesthesiology, general surgery, orthopedics, and gynecology. In 72.4% of the physicians, they responded that adrenaline is the first line of treatment, intramuscular route in 64.3%, correct dose in 50%; while other studies report that 70.9% of healthcare providers do not know the correct dose in an acute episode of anaphylaxis.…”

Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement

“…2 On the other hand, our colleagues from MGH have identified how untrained non-allergist staff fails to identify and treat anaphylaxis adequately even when consciously subjecting patients to high-risk allergy-specific procedures like intravenous DPT, 47,95 which is consistent with the published experience in anaphylaxis whether in the community or the hospital. [101][102][103][104][105][106] Creating a multidisciplinary team…”