Underreporting of anaphylaxis in a community emergency room

Klein, Joel S.; Yocum, Michael W.

doi:10.1016/s0091-6749(95)70329-2

Cited by 139 publications

(98 citation statements)

References 2 publications

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“…In addition, it is possible that some cases of anaphylaxis may not have been included due to the method of identification used. The lack of appropriate codes in the International Classification of Diseases, ICD-9, makes this classification insufficient to identify all anaphylactic reactions, particularly when only codes specifically indicating anaphylaxis are used [30][31]. The combination of several codes and the subsequent evaluation by an allergy specialist provides better results [15,32,33].…”

Section: Discussionmentioning

confidence: 99%

Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital

Guevara

Laffond

Bara

et al. 2018

J Investig Allergol Clin Immunol

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Background:To date, few studies have evaluated the degree of compliance with recommendations of anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines recommendations in an ED of a tertiary hospital. Methods: Medical records of patients that were assisted in the ED of the University Hospital of Salamanca (Spain) were reviewed. Those patients fulfilling anaphylaxis criteria proposed by the NIAID/FAAN were selected. Results: During one year period, we identified 89 patients, 74 adults and 15 children. In the 65% of adults the anaphylactic reaction was moderate, in 34% severe and in 1% very severe. In children, all reactions were moderate. Less than half (42%) of patients received adrenaline at ED, which was administered intramuscularly only in 19% of the cases. Regarding the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were no treated with adrenaline. At discharge from ED, an adrenaline auto-injector was recommended only to 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs. 27% children, p=0.047), 29% instructions about avoidance of triggers (31% adults vs. 20% children, n.s.), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs. 100% children, p<0.001). Conclusion: The results of the study show a large discrepancy between guidelines recommendations and anaphylaxis management in ED. Additional efforts in education to improve the treatment of patients with anaphylactic reactions are needed.

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Section: Discussionmentioning

confidence: 99%

Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital

Guevara

Laffond

Bara

et al. 2018

J Investig Allergol Clin Immunol

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“…Furthermore, this lack of specific criteria for diagnosing anaphylaxis has greatly hampered research into the epidemiology, pathophysiology, and management of this disorder; led to confusion on the part of first responders, emergency personnel, primary care physicians, and patients; and resulted in a failure to diagnose and treat anaphylaxis in a consistent manner. [1][2][3] In an attempt to resolve these problems, the National Institute of Allergy and Infectious Disease (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) convened a meeting in April 2004 to address these deficiencies. 4 This 2-day symposium brought together experts and representatives from 13 professional, governmental, and lay organizations to address the issue of defining and managing anaphylaxis.…”

mentioning

confidence: 99%

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Sampson

Muñoz-Furlong²,

Campbell

et al. 2006

Journal of Allergy and Clinical Immunology

1,909

1,114

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“…Indeed, studies have shown that a large percentage of patients (57%) who present to the ER with anaphylaxis are misdiagnosed 2, 3, 20, 21. The first line of evidence for diagnosing anaphylaxis includes clinical signs.…”

Section: Diagnosismentioning

confidence: 99%

“…These factors often lead to failure in the recognition of anaphylaxis. In fact, studies have shown that a large percentage of patients who present to the ER with anaphylaxis are misdiagnosed 2, 3, 4. In this review, we seek to highlight the current knowledge regarding the epidemiology, clinical presentation, diagnosis, and treatment of anaphylaxis in an ER setting.…”

Section: Introductionmentioning

confidence: 99%

Drug‐induced anaphylaxis in the emergency room

Takazawa

Oshima

Saito

2017

Acute Medicine & Surgery

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Anaphylaxis is a life‐threatening, systemic allergic reaction that presents unique challenges for emergency care practitioners. Anaphylaxis occurs more frequently than previously believed. Therefore, proper knowledge regarding the epidemiology, mechanisms, symptoms, diagnosis, and treatment of anaphylaxis is essential. In particular, the initial treatment strategy, followed by correct diagnosis, in the emergency room is critical for preventing fatal anaphylaxis, although making a diagnosis is not easy because of the broad and often atypical presentation of anaphylaxis. To this end, the clinical criteria proposed by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network are useful, which, together with a differential diagnosis, could enable a more accurate diagnosis. Additional in vitro tests, such as plasma histamine and tryptase measurements, are also helpful. It should be emphasized that adrenaline is the only drug recommended as first‐line therapy in all published national anaphylaxis guidelines. Most international anaphylaxis guidelines recommend injecting adrenaline by the intramuscular route in the mid‐anterolateral thigh, whereas i.v. adrenaline is an option for patients with severe hypotension or cardiac arrest unresponsive to intramuscular adrenaline and fluid resuscitation. In addition to the route of administration, choosing the appropriate dose of adrenaline is essential, because serious adverse effects can potentially occur after an overdose of adrenaline. Furthermore, to avoid future recurrence of anaphylaxis, providing adrenaline auto‐injectors and making an etiological diagnosis, including confirmation of the offending trigger, are recommended for patients at risk of anaphylaxis before their discharge from the emergency room.

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Underreporting of anaphylaxis in a community emergency room

Cited by 139 publications

References 2 publications

Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital

Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Drug‐induced anaphylaxis in the emergency room

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