An American College of Allergy, Asthma and Immunology study showed that even kids who were prescribed an epinephrine auto injector mostly didn't receive the life-saving medication when they needed it.
The study examined 408 patient records for children seen in an emergency department (ED) or urgent care (UC) setting for anaphylaxis. The records showed fewer than half the children received epinephrine prior to arriving at the ED or UC even though approximately 65% had a known history of anaphylaxis, and 47% had been prescribed epinephrine.
"We found kids who had a reaction at home were less likely to receive epinephrine than kids who had a reaction at school," says allergist Melissa Robinson, American College of Allergy, Asthma and Immunology (ACAAI) member and lead author of the study. "Treatment with epinephrine is often delayed or avoided by parents and caregivers. And sometimes antihistamines are used even though they are not an appropriate treatment."
Once they arrived at the ED/UC, only 50% of all patients received epinephrine. That number includes even those that got epinephrine before arrival. Because the study examined only if kids received epinephrine upon arrival at the ED/UC, there is no information on the reasons epinephrine wasn't given. The study did determine that children who received epinephrine prior to arrival were less likely to be treated with epinephrine once they arrived. Kids who received epinephrine prior to arrival were also more likely to be sent home compared to those who didn't.
"Allergists want parents, caregivers and emergency responders to know epinephrine should always be the first line of defense when treating anaphylaxis," says allergist David Stukus, member of the ACAAI public relations committee and co-author of the study.
"Our study found that only two-thirds of those who had an epinephrine prescription had their auto injector available at the time of their allergic reaction. It's vital to keep your epinephrine with you if you suffer from any sort of severe allergy. Anaphylaxis symptoms occur suddenly and can progress quickly. Always have a second dose with you and, when in doubt, administer it too. Anaphylaxis can be deadly if left untreated."
Anyone seen for anaphylaxis in the ED/UC needs to be referred to an allergist for a follow up visit. Allergists provide the most comprehensive follow-up care and guidance for severe allergic reactions.
Abstract
Background: Epinephrine is the first-line treatment for anaphylaxis but may be underused by patients and medical personnel.
Objective: To evaluate factors associated with anaphylaxis management before arrival at the emergency department (ED) or urgent care center (UCC).
Methods: We performed a retrospective review of electronic medical records for all patients aged 0 to 25 years presenting with anaphylaxis to the ED or UCC at a pediatric academic referral center during 2009 to 2013.
Results: A total of 408 patients (mean age, 7.25 years; 62% male) were included for analysis. Only 148 patients (36.3%) received epinephrine before arrival at the ED or UCC. Reactions occurring at home (n = 36/114) were less likely to be treated with epinephrine compared with reactions occurring at school (n = 30/49) (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.15–0.59). The odds of receiving epinephrine before arrival at the ED or UCC were significantly lower with a 2-organ system (OR, 0.50; 95% CI, 0.30–0.85) or 3-organ system (OR, 0.41; 95% CI, 0.21–0.81) presentation compared with 1-organ system involvement. Foods (342 [83.8%]) were the most commonly reported provoking trigger. Patients who did not receive epinephrine before arrival at the ED or UCC were significantly less likely to be discharged to home (OR, 0.56; 95% CI, 0.37–0.86; P = .01).
Conclusion: This study identifies factors associated with prehospital management of anaphylaxis for children, which highlight that epinephrine administration may be occurring with considerable delay. Increased awareness and education of caregivers, patients, and medical professionals are necessary to provide optimal management.
Authors
Melissa Robinson, Matthew Greenhawt, David R Stukus
[link url="http://acaai.org/news/half-kids-who-needed-epinephrine-didnt-get-it-trip-emergency-room"]American College of Allergy, Asthma and Immunology material[/link]
[link url="http://www.annallergy.org/article/S1081-1206(17)30466-0/fulltext"]Annals of Allergy, Asthma and Immunology abstract[/link]