Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital

• Published in: Journal of investigational allergology & clinical immunology Vol. 28; no. 4; p. 243
• Main Authors: Guevara, LV Ponce, Laffond, Yges E, Bara, MT Gracia, Rodilla, E Moreno, Bellido, FJ Muñoz, Sastre, M Lázaro, Iglesias, EM Macías, Méndez, S de Arriba, Toro, MV Campanón, Gónzalez, I Dávila
• Format: Journal Article
• Language: English
• Published: Barcelona Esmon Publicidad 01-01-2018
• Subjects: Allergies; Anaphylaxis; Children; Epinephrine; Medical records; Patients
• ISSN: 1018-9068; 1698-0808

Background: Few studies have evaluated adherence to anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines in the ED of a tertiary hospital. Methods: Medical records of patients attended in the ED of University Hospital of Salamanca, Spain were reviewed. Those patients fulfilling the anaphylaxis criteria proposed by the NIAID/FAAN were selected. Results: During a 1-year period, we identified 89 patients (74 adults and 15 children). The anaphylactic reaction was moderate in 65% of adults, severe in 34%, and very severe in 1%. In children, all reactions were moderate. Fewer than half of the patients (42%) received adrenaline in the ED; this was administered intramuscularly in only 19% of cases. As for the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were not treated with adrenaline. At discharge from the ED, an adrenaline auto-injector was recommended to only 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs 27% children, P=.047), 29% instructions about avoidance of triggers (31% adults vs 20% children, NS), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs 100% children, P<.001). Conclusion: The results of the study show a large discrepancy between recommendations in guidelines and management of anaphylaxis in the ED. Additional training efforts are needed to improve the treatment of patients with anaphylactic reactions.