Implementation of Anaphylaxis Management Guidelines: A Register-Based Study

Abstract

BackgroundAnaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines.MethodsWithin the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data.Results2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time.ConclusionThere is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted.

Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

“…[16] That study, performed using the transnational anaphylaxis registry of Germany, Austria, and Switzerland, confirmed major discrepancies in treatment and follow-up and recommended a revised approach to management, including training and education. No data exist for the US.…”

Anaphylaxis treatment: current barriers to adrenaline auto-injector use

“…Data from several cohort studies illustrate the extent of under-treatment of anaphylaxis and the low rate of adrenaline use (12,15,(39)(40)(41), with most cases of anaphylaxis that require hospitalization not receiving an AAI on discharge. Adrenaline is much less commonly used than antihistamines and corticosteroids in treating anaphylaxis despite both antihistamines (42) and corticosteroids (43,44) having an onset of action that is delayed and too late to prevent respiratory and/ or cardiovascular arrest, which can occur within minutes (23).…”

“…From the anaphylaxis registry that includes 83 centres in Germany, Austria and Switzerland, validated data from 58 of the centres and consisting of 2114 consecutive cases (2006-2010) of severe anaphylaxis were recently analysed (41), to establish the degree of compliance with treatment recommendations. This study revealed that adrenaline was given to only 13.8% of the patients, with just 3.9% receiving im injection (Fig.…”

Drug‐induced anaphylaxis in the emergency room

“…Intravenous adrenaline is an option in patients with severe hypotension or cardiac arrest unresponsive to intramuscular doses of adrenaline and fluid resuscitation 1. Despite these therapeutic benefits of adrenaline and the recommendations for its use, adrenaline injection rates remain low in many ERs37, 38 (Fig. 5).…”

“…Drugs used for emergency treatment of anaphylaxis, according to age 37. The dashed lines indicate the proportion of patients who received only inhalation (adrenaline) or oral (antihistamine or corticoid) treatment.…”