Less than 50% of children who experience anaphylaxis receive epinephrine before treatment in an ED or urgent care center, despite the medication being the first line of defense against the condition, according to a study published in the Annals of Allergy, Asthma and Immunology.
“Despite the availability of multiple published guidelines regarding anaphylaxis management, there continue to be deficiencies in treatment, particularly for children,” Melissa Robinson, DO, from the Section of Allergy and Immunology at National Jewish Hospital, and colleagues wrote. “Research has shown poor understanding of indications for the use of epinephrine among families with food allergic children, school nurses and emergency responders, likely contributing to the underuse of epinephrine before the arrival at the ED.”
To assess how anaphylaxis is managed before arrival to an ED or urgent care center (UCC) for children, the researchers conducted a retrospective review of electronic medical records for people between the ages of 0 and 25 years. All had presented to the ED or UCC within a pediatric academic referral center between 2009 and 2013 with anaphylaxis.
The average age of the 408 patients included was 7.25 years, and 62% were male. Epinephrine was administered to only 36.3% of those included in the study before arrival for treatment. Children were more likely to receive epinephrine if their reaction occurred at school (n = 30/49) than if anaphylaxis occurred in the home (n = 36/114).
When one organ system was involved with anaphylaxis, children were more likely to receive epinephrine before treatment than they were if two-organ (OR = 0.50; 95% CI = 0.30-0.85) or three-organ systems (OR = 0.41; 95% CI = 0.21-0.81) were affected. Patients were most likely to have a reaction catalyzed by a food allergy (83.8%) — usually peanuts or tree nuts — and those who did not receive epinephrine before treatment were less likely to be discharged (OR = 0.56; 95% CI = 0.37-0.86; P = 0.01)
“Multiple past studies have corroborated the finding that epinephrine is reported as not always available or, worse, available and not used, a finding in particular associated with food allergy fatality in teenagers and young adults,” Robinson and colleagues wrote. “The circumstances of why this finding persists are beyond the scope of this study but may relate to social disparities, access to specialty care or multiple physician-related factors that have [an] influence on how subsequent reactions are managed.” – by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.