Anaphylaxis in the emergency department: a paediatric perspective

Martelli, Alberto M.; Ghiglioni, Daniele Giovanni; Sarratud, Teresita; Calcinai, Elena; Veehof, Suzanne; Terracciano, Luigi; Fiocchi, Alessandro

doi:10.1097/aci.0b013e328307a067

Cited by 16 publications

(7 citation statements)

References 71 publications

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“…Our audit reveals a number of obstacles and deficiencies which have been highlighted in multiple reviews examining the management of anaphylaxis [ 3 5 6 ]. The first major obstacle relates to the lack of a simple definition of anaphylaxis that can be easily recalled from memory by emergency staff.…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis audit in a busy metropolitan Emergency Department: a review of real life management compared to best practice

Murad

Katelaris

2016

Asia Pacific Allergy

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BackgroundDeficiencies in anaphylaxis management in Emergency Departments is well recognised despite established guidelines for its treatment.ObjectiveTo identify deficiencies in the management of anaphylaxis in a busy metropolitan Emergency Department and determine if an education intervention could correct these.MethodsPaediatric and adult admissions to the Emergency Department of a busy hospital were tracked over a 10-month period with a targeted educational program being instituted at 5 months. The electronic records were retrospectively reviewed looking for cases of anaphylaxis and milder forms of immediate type allergic reactions presenting with a combination of urticaria and nonairway threatening angioedema. Anaphylaxis presentation was graded using the Brown grading system. Use of all medication during resuscitation was documented. Observation period before discharge and referral to specialist unit for follow-up was noted.ResultsIn the first 5 months, 38 patients fulfilled our criteria. Three had severe anaphylaxis, 13 had moderately severe anaphylaxis and 12 had urticaria and angioedema without anaphylaxis. Anaphylaxis was not always recognised or graded leading to inappropriate management with adrenaline often being withheld. Promethazine, usually given in parenteral form, was frequently administered. Observation time was often inadequate. Referral to an immunologist was not universally followed through. Following the educational intervention 58 patients fulfilled our criteria over the next 5 months. The appropriate use of adrenaline increased by 21% and the use of sedating antihistamines decreased by 16%, while the number of referrals to an immunologist increased by 24%. There was an 11% reduction in the number of patients who were observed for at least 4 hours.ConclusionA number of deficiencies in the management of anaphylaxis presentations have been identified. Targeted educational activities aimed at the Emergency Department hospital staff may improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Anaphylaxis audit in a busy metropolitan Emergency Department: a review of real life management compared to best practice

Murad

Katelaris

2016

Asia Pacific Allergy

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“…The percentage of patients referred to an allergist specialist after an anaphylactic reaction varies from 15% to 33%. Some authors have proposed that a multidisciplinary approach involving allergists and other specialists could improve the management of these patients in emergency departments and their follow‐up after discharge (16, 17). Educational activities such as seminars have proved to be useful educating caregivers (18).…”

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confidence: 99%

Improving anaphylaxis management in a pediatric emergency department

Arroabarren

Lasa

Olaciregui

et al. 2011

Pediatric Allergy Immunology

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“…The reaction may be fatal unless treatment is given immediately. At presentation in the emergency room, anaphylaxis may not be recognized if it is triggered by a novel agent, if it is an individual's first episode, or if it occurs in an infant or young child or in an aphonic, dyspnoeic, or unconscious individual [46].…”

Section: Acute and Chronic Food Protein-induced Enterocolitis Syndromementioning

confidence: 99%

Differential diagnosis of food protein-induced enterocolitis syndrome

Fiocchi

Claps

Dahdah

et al. 2014

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewTo assess all the possible differential diagnosis of food protein-induced enterocolitis syndrome (FPIES), both in acute and chronic presentation, reviewing the data reported in published studies.Recent findingsThere is an increase of reported cases of FPIES in recent years. As the disease presents with nonspecific symptoms, it can be misunderstood in many ways. The differential diagnosis includes, in acute presentations, the following: sepsis, other infectious diseases, acute gastrointestinal episodes, surgical emergencies, food allergies. In its chronic forms, FPIES may mimic malabsorption syndromes, metabolic disorders, primary immunodeficiencies, neurological conditions, coagulation defects, and other types of non-IgE-mediated food allergy.SummaryA thorough clinical evaluation, including symptoms, signs, and laboratory findings, is necessary to lead the clinicians toward the diagnosis of FPIES. The major reason for delayed diagnosis appears to be the lack of knowledge of the disease.

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Anaphylaxis in the emergency department: a paediatric perspective

Abstract: As gross differences have been described in the awareness of the disease and its management between allergists and nonallergists, allergists should interact with emergency doctors to improve education in this area.

Cited by 16 publications

References 71 publications

Anaphylaxis audit in a busy metropolitan Emergency Department: a review of real life management compared to best practice

Anaphylaxis audit in a busy metropolitan Emergency Department: a review of real life management compared to best practice

Improving anaphylaxis management in a pediatric emergency department

Differential diagnosis of food protein-induced enterocolitis syndrome

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