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Increased use of adrenaline in the management of childhood anaphylaxis

Published online: January 15, 2018

The dramatic increase in anaphylaxis has occurred in parallel with the worldwide increase in allergic diseases in general, particularly in the pediatric population. Prompt treatment with adrenaline, the only first-line intervention for anaphylaxis, is recommended for all age groups to prevent potentially fatal progression. However, there is evidence that adrenaline has been significantly underused and general management may be suboptimal.

In this article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Rueter and colleagues investigated whether allergy training programs and improved cooperation between Emergency Physicians and Clinical Immunologists changed the management of anaphylaxis in a tertiary Pediatric Emergency Department (PED) over a 10-year period. The researchers compared the management of anaphylaxis across two periods: 2003/2004 and 2012. In 2003/2004, 92 verified anaphylaxis cases were identified from among 83,832 PED-presentations. These cases were compared with 159 cases of anaphylaxis from 71,822 PED-presentations in 2012. A significantly higher proportion of cases were appropriately managed with adrenaline in 2012 compared to 2003/2004, when intensive training programs had not yet been introduced (p=0.03). Vital signs were more frequently documented in 2012 (p<0.001) than in 2003/2004, and there was significantly less administration of other medications (corticosteroids, bronchodilators, antihistamines) in 2012 (p<0.05). Also, changes in discharge management occurred with improved dispensing/prescription of adrenaline-autoinjectors and more frequent follow-up arrangement with specialist allergy services recorded in 2012 (p<0.001).

This is the first study to show improvements in identification, management and arrangement of follow-up for anaphylaxis in a PED over a ten-year period following an intensified training program for medical staff and improved cooperation between Pediatric Emergency Specialists and Allergists/Immunologists. Immediate recognition of anaphylaxis and prompt treatment with adrenaline is crucial given the risk of death, the considerable morbidity and the significant burden for the health care system. This study provides a platform for large well-designed prospective studies looking at the impact of training programs where Emergency and Allergy/Immunology departments cooperate to optimize anaphylaxis identification, management and follow-up.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.