Use of Epinephrine in Patients with Drug-Induced Anaphylaxis: An Analysis of the Beijing Pharmacovigilance Database

Abstract

Background: Few studies assessing the use of epinephrine in drug-induced anaphylaxis (DIA) in the hospital setting are available. We utilized the Beijing Pharmacovigilance Database (BPD) to evaluate the appropriateness of epinephrine for DIA management. Methods: DIA cases collected in the BPD from January 2004 to December 2014 were adjudicated and analyzed for demographics, causative drugs, clinical signs, outcomes, initial treatment, route, dosing, and cardiovascular adverse events (CAE) of epinephrine. Results: DIA was primarily caused by antibiotics (38.4%), radiocontrast agents (11.9%), traditional Chinese medicine injections (10.9%), and chemotherapeutic drugs (10.3%). Only 708 (59.5%) patients received epinephrine treatment. Patients who received epinephrine were more likely to experience wheezing (p < 0.001) and respiratory arrest (p < 0.001). Among 518 patients with a complete record of the epinephrine administration route, the percentage of patients receiving it by intramuscular (IM) injection, subcutaneous (SC) injection, intravenous (IV) bolus injection, or IV continuous infusion was 16.9, 31.5, 43.5, and 8.1%, respectively. Among the 427 patients with a record of both the administration route and the dosing, an overdose was more likely with IV bolus (94.1%) in contrast to IM injection (56.6%; p < 0.001) or SC injection (43.7%; p < 0.001). Among the patients analyzed for CAE (n = 349), 17 patients accounted for 19 CAE, and 13 (76.5%) of these patients were overdosed with epinephrine. Conclusion: Underuse, inappropriate IV bolus use, and overdosing were the 3 major problems with epinephrine use in DIA in China. Educational training for health care professionals on the appropriate use of epinephrine in managing anaphylactic reactions is suggested.

Drug-induced anaphylaxis in China: a 10 year retrospective analysis of the Beijing Pharmacovigilance Database

“…Using a structured database inquiry, extraction, and case adjudication methodology as reported in our previous study [ 10 ], we performed a detailed analysis on DIA cases. The cases were reported to the BPD from January 1, 2004 to December 31, 2014.…”

“…In contrast with our previous study [ 10 ], anaphylaxis-inducing drugs were classified into various pharmacotherapeutic groups according to the Martindale—The Complete Drug Reference (37th edition) [ 11 ], World Health Organization (WHO) Model Formulary (2008) [ 12 ], and Chinese Pharmacopoeia (ChP) [ 13 ]. Within each group there were several subgroups.…”

“…Studies are needed to confirm the previous findings and to add new knowledge to this area in Asian population. Our previous study assessed the use of epinephrine in managing patients with DIA through the analysis of the Beijing Pharmacovigilance Database (BPD) [ 10 ], and the present study is an extension of this project to provide a detailed analysis of the reported DIA cases.…”

Recent Advances in Clinical Allergy and Immunology

“…Furthermore, underuse, inappropriate IV bolus use, and overdose were identified as major problems with epinephrine use, emphasizing the importance of training for professionals and education for patients [100]. …”

Emergency Management of Anaphylaxis in Chinese Primary Care Units: Systematic Analysis of 77 Cases

“…However, prevalent clinical practices with respect to emergency treatment of anaphylaxis in Chinese primary care units are not well identi ed. Limited studies found under-use and/or inappropriate use of epinephrine during treatment of anaphylaxis in China [4][5][6] , but all these studies were investigated in large hospitals in Beijing before the year of 2014; in addition, these reports did not provide speci c information about the critical initial treatment of anaphylaxis. Accordingly, we evaluated the actual emergency treatment of anaphylaxis initially treated in Chinese primary care units by analyzing published cases during period of 2014 to 2018.…”