Use of epinephrine in emergency department depends on anaphylaxis severity in children

Description of two anaphylaxis phenotypes in children: The utility of a clustering analysis approach

“…4 Our results confirm also that peanut and tree nuts, involved in Our results also confirmed that children with more severe allergic reactions (cluster 1) were older than those with less severe reaction and allergic disease (cluster 2), as described in the Mirabel study. 5 However, adolescence was not associated with more severe reaction in our study which is different than previously reported in registries collecting data of severe or fatal cases. 8 We did not confirm a clear impact of the gender on the severity of food allergic reactions.…”

Evidence update for the treatment of anaphylaxis

“… 1 , 12 , 14 , 16 This is based on a large number of datasets which report that the majority of patients presenting with anaphylaxis to Emergency Departments are treated with antihistamines, yet only a minority receive adrenaline – despite an increasing emphasis on adrenaline as the first-line intervention in international guidelines. 62 , 63 , 64 , 65 , 66 , 67 , 68 In a large, national prospective registry (Cross-Canada Anaphylaxis Registry, C-CARE), 3498 cases of anaphylaxis were enrolled over a 6 year period; prehospital antihistamine use was associated with a lower rate of administration of >1 adrenaline dose (adjusted OR 0.61; 95% CI 0.44–0.85), but not other outcomes (hospitalisation/intensive care, intravenous fluids). Moreover, this finding was not robust at sensitivity analyses: excluding less severe reactions, prehospital antihistamine did not affect outcomes; unfortunately, the authors did not assess the impact on >2 doses of adrenaline being given.…”

“…As with antihistamines, corticosteroids are administered far more frequently than adrenaline for the acute treatment of anaphylaxis, 62 , 63 , 64 , 65 , 66 , 67 , 68 , 70 implying that their use may distract from the need to administer adrenaline. However, of greater concern is emerging evidence that routine use of corticosteroids for anaphylaxis may be harmful, and associated with increased morbidity even after correcting for confounding by indication.…”

Pediatric Anaphylaxis: Etiology and Predictive Factors in an Emergency Setting

“…The number of proper intramuscular adrenaline for anaphylaxis treatment at the emergency room in the study population was high compared to some other previous reports. 11 This is because of the present study retrospectively included patients diagnosed with anaphylaxis in a tertiary care setting. Physicians at the emergency department had proper standard guideline for anaphylaxis treatment.…”