Adults and children with anaphylaxis in the emergency room: why it is not recognized? (original) (raw)
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Anaphylaxis Attended in Emergency Departments: a Reliable Picture of Real-world Anaphylaxis
Current Treatment Options in Allergy, 2020
Purpose of review The aim of this document is to review the epidemiology of anaphylaxis in the emergency departments (EDs) (burden and temporal trends), the generally deficient management of anaphylaxis in the ED, and the measures and interventions tested in different settings to improve management of anaphylaxis in the ED. Recent findings The population attended for anaphylaxis episodes is low (0.009 to 0.4%). Recent studies report an increase in anaphylaxis episodes attended in the ED. Discordance has been observed between the diagnosis of anaphylaxis in the ED and the diagnosis confirmed in allergy units; this can reach 45%. Management of anaphylaxis is not consistent with international guidelines, and the lack of adherence to guidelines affects the use of epinephrine in the ED, prescription of epinephrine autoinjectors, initial advice on avoidance, and referral to an allergist. Measures to improve the management of anaphylaxis have proven effective. Summary The low burden of anaphylaxis in the ED and the disappointing landscape of management of this syndrome in the ED should drive strategies aimed at providing staff with key concepts and measures that enable them to manage episodes of anaphylaxis effectively.
Journal of investigational allergology & clinical immunology, 2015
To contrast the initial suspected etiology of anaphylaxis with the postworkup diagnosis in patients attended at the emergency department (ED) of a tertiary-level hospital in Spain and to investigate the incidence, causes, and management of anaphylaxis. We performed an observational study of patients aged more than 15 years who came to the ED with anaphylaxis between 2009 and 2010. All clinical records from the ED were reviewed. We recorded data on clinical management, the etiology proposed by the attending emergency physician, and the cause reported by the patient. The findings were compared with the diagnosis reached after the allergy workup. The incidence of anaphylaxis was 0.08%. The most common manifestation was skin-mucosal symptoms (98.3%). Anaphylaxis was diagnosed in the ED in only 44% of the cases, regardless of severity. Only 39.7% received epinephrine, which was administered more frequently when the ED physician diagnosed anaphylaxis, regardless of severity. A total of 60...
Emergency department anaphylaxis: A review of 142 patients in a single year
Journal of Allergy and Clinical Immunology, 2001
Background: There are few data on the incidence, clinical features, and management of patients with acute anaphylaxis presenting to the emergency department. We investigated all presentations to one department during the course of a year to improve current awareness of this medical emergency. Objective: The purpose of the study was to describe the clinical features, management, and outcome of anaphylaxis presentations to a single Australian adult emergency department in a single year, 1998-1999. Methods: This was a retrospective, case-based study of adult patients (≥13 years of age) attending a single emergency department in Brisbane, Australia, during the year 1998-1999. The medical records of 304 patients satisfying the relevant discharge diagnostic codes were studied. We determined incidence, sex ratio, age, clinical features, management, disposal, asthma prevalence, and causes in patients presenting with acute allergic reactions and anaphylaxis. Results: In all, 162 emergency department patients with acute allergic reactions and 142 emergency department patients with anaphylaxis, including 60 whose anaphylaxis was severe, were seen during the year, for an anaphylaxis presentation incidence of 1 in 439. One patient died; this gave a case fatality rate of 0.70%. Cutaneous features were present in 94% of the patients with anaphylaxis. Of those with severe anaphylaxis, 35% had dizziness/syncope before hospital presentation, 25% laryngeal edema, and 21.7% systolic hypotension on hospital presentation. A cause was recognized in 73% of the anaphylaxis cases; most commonly, the causative agent was a drug, insect venom, or food. Adrenaline was used in 57% of the severe cases before hospital presentation or in the hospital. The emergency department alone definitively cared for 94% of all patients, though only 43% severe anaphylaxis cases were referred for follow-up. Conclusion: The emergency department anaphylaxis presentation incidence of 1 in 439 cases is greater than previously recognized, though death remains rare. In three fourths of cases, a precipitant was identified, a fact that emphasizes the need for a detailed initial history. Definitive management in the emergency department alone is possible in most cases, provided that the appropriate use of adrenaline and the need for allergy clinic follow-up are appreciated. (J Allergy Clin Immunol 2001;108:861-6.)
Anaphylaxis Overview: Addressing Unmet Patient Needs
The Journal for Nurse Practitioners, 2015
Anaphylaxis is widely recognized as a life-threatening condition, yet there is a gap between what patients know and need to know in an emergency situation. Anaphylaxis falls into a category of severe and dangerous conditions that places the supreme responsibility of symptom recognition and immediate life-saving treatment directly on the patient. Recent research illuminates that patients are unable to readily recognize the symptoms of anaphylaxis and often do not have an epinephrine autoinjector available for self-treatment. Because most anaphylactic reactions occur outside of the medical office, every possible opportunity to teach patients how to self-treat should be optimized.
Anaphylaxis: a ten years inpatient retrospective study
The actual incidence of anaphylaxis is unknown. Periodical study of the anaphylaxis in different countries will raise the awareness to improve further the prevention and care. To investigate anaphylaxis among inpatients in the previous decade, we conducted a retrospective study of adult patients between 1992 and 2001 at a tertiary care center in Bangkok. Of 448,211 admissions, 80 events of anaphylaxis in 79 patients (0.017%) were found. The incidence had increased from 2.6 to 46 per 100,000 inpatients. Mean age +/- SD was 36 +/- 16 years-old, with an equal male:female ratio. Drugs, mainly antibiotics and nonsteroidal anti-inflammatory agents, (48%) and food (31%) were the most common causes. Over-the-counter medication and multiple drug use were responsible for up to a half of the unspecified drug causes. There was no fatality. 84% received epinephrine, but in only 7% it was given intramuscularly. Fifteen cases (20%) had a history of prior anaphylaxis, nonetheless only one had received prefilled epinephrine. The rise in the incidence of anaphylaxis over the two decades of the study period is alarming. Raising the awareness of anaphylaxis management among healthcare providers and the public is warranted.
Future doctors and anaphylaxis: What do they know? what should we do?
Annals of Medical Research, 2019
Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction. Previous studies reveal that there are many potential deficiencies in the knowledge of doctors regarding the diagnosis and management of anaphylaxis in different healthcare settings.The main purpose of this study was to assess the knowledge of 4th-6th-year medical students regarding the diagnosis and management of anaphylaxis. Material and Methods: The study was designed as a cross-sectional survey. The total number of 4th-, 5th-, and 6th-grade medical students at Trakya University Medical School was 651, and 172 (26%) agreed to participate in the study. The participants were asked to answer the questionnaire forms were including the questions assessing students' knowledge about the diagnosis and management of anaphylaxis, before and after a training session about anaphylaxis. Results:Awareness of students about symptoms indicating anaphylaxis other than cutaneous and respiratory symptoms was between 40% and 77% in the initial test. Although the majority of participants (94%) chose epinephrine as the first-line drug for the treatment of anaphylaxis, correct answers about dosage, concentration, and the route for administration of epinephrine were low when compared with the final test (p < 0.001 for each item). While 14% stated they felt they could diagnose and treat anaphylaxis in the initial test, this increased 83% after the training (p < 0.001). Conclusion: The study revealed that, knowledge of medical students relating diagnosis and treatment of anaphylaxis is unsatisfactory. Much more attention is needed in medical-school education concerning anaphylaxis management to prevent anaphylaxis-related mortalities in the future.
Anaphylaxis: epidemiology, aetiology and relevance for the clinic
Expert Review of Clinical Immunology, 2017
anaphylaxis management plans should be a routine component of this longer-term care with provision of adrenaline auto-injectors to those at risk of further episodes of anaphylaxis. More generally, there is a need to ensure that there are standard protocols in place to ensure that risks of triggering anaphylaxis are minimised and appropriate acute and long-term care are provided if reactions occur. Expert commentary It is important to be aware that anaphylaxis may occur in patients of any age, sex or ethnicity. Early recognition and prompt treatment with adrenaline are potentially life-saving. Careful assessment of risk and appropriate long-term management are key to improving long-term outcomes in those at risk of repeat episodes of anaphylaxis.