Anaphylaxis in an emergency setting – elicitors, therapy and incidence of severe allergic reactions

Beyer, Kirsten; Eckermann, Oliver; Hompes, S.; Grabenhenrich, Linus; Worm, Margitta

doi:10.1111/all.12012

Cited by 104 publications

(88 citation statements)

References 35 publications

(52 reference statements)

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“…Orhan et al found that only 32.2% of their patients received epinephrine as treatment for anaphylaxis [17]. Beyer et al also found a low percentage of use of epinephrine in the ED in Berlin, where it was used in only 22.7% of cases [18]. Alvarez Perea et al, in an observational study of patients aged more than 15 years attended at the ED of a tertiary-level hospital in Spain, found that only 40% of patients received epinephrine, which was administered more frequently when the ED physician diagnosed anaphylaxis, regardless of severity [19].…”

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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“…Food allergy, particularly to peanuts, tree nuts, egg, and milk, is the leading cause of anaphylaxis (7)(8)(9)(10). Allergen avoidance education is often targeted at avoidance within the home, with less emphasis on how to avoid community exposure.…”

Section: Why the Community Is Importantmentioning

confidence: 99%

EAACI Food Allergy and Anaphylaxis Guidelines: managing patients with food allergy in the community

Muraro¹,

Agache²,

Clark³

et al. 2014

Allergy

142

155

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The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to meet the needs of early-childhood and school settings as well as providers of non-prepackaged food (e.g., restaurants, bakeries, takeaway, deli counters, and fast-food outlets) and targets the audience of individuals with FA, their families, patient organizations, the general public, policymakers, and allergists. Food allergy is the most common trigger of anaphylaxis in the community. Providing children and caregivers with comprehensive information on food allergen avoidance and prompt recognition and management of allergic reactions are of the utmost importance. Provision of adrenaline auto-injector devices and education on how and when to use these are essential components of a comprehensive management plan. Managing patients at risk of anaphylaxis raises many challenges, which are specific to the community. This includes the need to interact with third parties providing food (e.g., school teachers and restaurant staff) to avoid accidental exposure and to help individuals with FA to make safe and appropriate food choices. Education of individuals at risk and their families, their peers, school nurses and teachers as well as restaurant and other food retail staff can reduce the risk of severe/fatal reactions. Increased awareness among policymakers may improve decision-making on legislation at local and national level.

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“…Although the ratio of patients with anaphylaxis to all patients admitted to the ER was reportedly 0.08%,4 this ratio was likely to have been underestimated due to the difficulty in diagnosing anaphylaxis. In general, foods are the most common cause of anaphylaxis, although there is a wide variation in the ratio of food‐/non‐food‐induced anaphylaxis among studies 4, 6, 7, 8, 9. An important factor affecting the etiology of anaphylaxis is patient age 6, 10, 11, 12.…”

Section: Epidemiologymentioning

confidence: 99%

“…Concomitant symptoms of the skin and mucosal tissue, respiratory symptoms, and gastrointestinal symptoms were documented in 81.4%, 74.6%, and 31.5% of cases, respectively (Table 1). 8 The author pointed out that the symptoms in children and young adults are a little different from those in the elderly. For example, generalized pruritus and urticaria, vomiting, and diarrhea were more often reported in children and young adults 8.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…8 The author pointed out that the symptoms in children and young adults are a little different from those in the elderly. For example, generalized pruritus and urticaria, vomiting, and diarrhea were more often reported in children and young adults 8. Therefore, emergency physicians should be aware that the clinical signs and symptoms of anaphylaxis vary depending on the age group of the patients.…”

Section: Clinical Presentationmentioning

confidence: 99%

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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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Anaphylaxis in an emergency setting – elicitors, therapy and incidence of severe allergic reactions

Cited by 104 publications

References 35 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

EAACI Food Allergy and Anaphylaxis Guidelines: managing patients with food allergy in the community

Drug‐induced anaphylaxis in the emergency room

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