Addressing barriers to emergency anaphylaxis care: from emergency medical services to emergency department to outpatient follow-up

• Published in: Annals of allergy, asthma, & immunology Vol. 115; no. 4; pp. 301 - 305
• Main Authors: Fineman, Stanley M., MD, Bowman, Steven H., MD, Campbell, Ronna L., MD, PhD, Dowling, Paul, MD, O’Rourke, Dianne, MPA, Russell, W. Scott, MD, Sublett, J. Wesley, MD, MPH, Wallace, Dana, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2015
• Subjects: Allergy and Immunology; Anaphylaxis - diagnosis; Anaphylaxis - drug therapy; Anaphylaxis - epidemiology; Consensus; Diagnostic Errors - statistics & numerical data; Emergency Medical Services - methods; Emergency Service, Hospital; Epinephrine - therapeutic use; Follow-Up Studies; Humans; Outpatients; Tryptases - blood
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/j.anai.2015.07.008

Abstract Background Anaphylaxis is a systemic life-threatening allergic reaction that presents unique challenges for emergency care practitioners. Allergists and emergency physicians have a history of collaborating to promote an evidence-based, multidisciplinary approach to improve the emergency management and follow-up of patients with or at risk of anaphylaxis. Objectives To review recent scientific literature about anaphylaxis, discuss barriers to care, and recommend strategies to support improvement in emergency anaphylaxis care. Methods An expert panel of allergists and emergency physicians was convened by the American College of Allergy, Asthma and Immunology in November 2014 to discuss current knowledge about anaphylaxis, identify opportunities for emergency practitioners and allergists to partner to address barriers to care, and recommend strategies to improve medical management of anaphylaxis along the continuum of care: from emergency medical systems and emergency department practitioners for acute management through appropriate outpatient follow-up with allergists to confirm diagnosis, identify triggers, and plan long-term care. Results The panel identified key barriers to anaphylaxis care, including difficulties in making an accurate diagnosis, low rates of epinephrine administration during acute management, and inadequate follow-up. Strategies to overcome these barriers were discussed and recommendations made for future allergist/emergency physician collaborations, and key messages to be communicated to emergency practitioners were proposed. Conclusion The panel recommended that allergists and emergency physicians continue to work in partnership, that allergists be proactive in outreach to emergency care practitioners, and that easy-to-access educational programs and materials be developed for use by emergency medical systems and emergency department practitioners in the training environment and in practice.