Epinephrine Auto-Injector Parental Survey and Skills Demonstration

Abstract

Urticaria is a common reason for emergency department (ED) visits. In guidelines published in 2014, second-generation H1 antihistamines are recommended as first line oral therapy and are advantageous as they are long-acting and usually non-sedating. We hypothesized that oral first-generation H1 antihistamines are still prescribed in the ED and at discharge more often than oral second-generation antihistamines despite the recent guidelines published. METHODS: A retrospective chart review was performed on adults who were discharged from the ED with a diagnosis of urticaria (ICD10 code L50.x). ED treatment and medications at discharge were recorded. The protocol was approved by the IRB. Charts were reviewed from June 2014 to December 2014 and from June 2017 to June 2018. RESULTS: The majority of patients had acute urticaria with an unknown trigger. In 2014, 69% of patients (31 of 45) were treated with H1 antihistamines in the ED: of antihistamines administered, 27% were first-generation parenteral antihistamines and 58% were oral first-generation antihistamines. In 2017-18, 68% (68 of 100) were treated with H1 antihistamines in the ED: of anithistamines administered, 19% were parenteral first-generation antihistamines and 67% were oral first-generation antihistamines. Upon discharge, 80% of patients in both time periods were prescribed oral H1 antihistamines: 83% and 74% were recommended first-generation sedating antihistamines before and after 2014, respectively (no significant difference). CONCLUSIONS: First-generation H1 antihistamines remain the primary treatment of urticaria in the ED and upon discharge. This indicates a potential opportunity to alter practice and provide better outcomes by encouraging implementation of published treatment guidelines.