Y Mostmans1, M Grosber1, M Blykers1, P Mols2, N Naeije3, J Gutermuth1. 1. Department of Dermatology, Universitary Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium. 2. Service des Urgences et du SMUR, C.H.U. Saint-Pierre, Brussels, Belgium. 3. Clinic of Immuno-allergology, C.H.U. Brugmann, Brussels, Belgium.
Abstract
BACKGROUND: Anaphylaxis is a life-threatening emergency of which reliable epidemiological data are lacking. This study aimed to analyze how quickly patients presenting with anaphylaxis were treated in emergency and whether treatment followed the European Academy of Allergy and Clinical Immunology (EAACI) guidelines. METHODS: Patient data were collected between April 2009 and April 2013. Emergency doctors completed a questionnaire for adult patients presenting at the emergency department (ED) of the St. Pierre hospital in Brussels with anaphylaxis. Inclusion criteria were based on the Sampson criteria of anaphylaxis. Data were analyzed using a Microsoft Excel database. RESULTS: About 0.04% (100/230878) of all emergency visits in adults presented with anaphylaxis. 64% of patients received their first medical help later than 30 min after symptom onset. 67% of patients received adrenaline, 85% oral antihistamines, and 89% received IV glucocorticosteroids. 46/100 patients were discharged directly from the ED, of which 87% received further medical prescriptions for self-administration: 67% corticosteroids, 83% antihistamines, and 9% intramuscular adrenaline. 74% were instructed to consult an allergologist for adequate diagnosis. 54/100 patients were hospitalized. CONCLUSION: The majority of patients were treated according to the EAACI guidelines for management of anaphylaxis, but only a minority received the recommended adrenaline auto-injector for self-administration at discharge. Because the majority of patients received medical help later than 30 min after symptom onset, adrenaline auto-injector prescription is a necessity. The low rate of doctors prescribing adrenaline auto-injectors in the ED setting underlines the need to train doctors of various backgrounds in prevention and treatment of anaphylaxis and the close collaboration with allergologists.
BACKGROUND: Anaphylaxis is a life-threatening emergency of which reliable epidemiological data are lacking. This study aimed to analyze how quickly patients presenting with anaphylaxis were treated in emergency and whether treatment followed the European Academy of Allergy and Clinical Immunology (EAACI) guidelines. METHODS:Patient data were collected between April 2009 and April 2013. Emergency doctors completed a questionnaire for adult patients presenting at the emergency department (ED) of the St. Pierre hospital in Brussels with anaphylaxis. Inclusion criteria were based on the Sampson criteria of anaphylaxis. Data were analyzed using a Microsoft Excel database. RESULTS: About 0.04% (100/230878) of all emergency visits in adults presented with anaphylaxis. 64% of patients received their first medical help later than 30 min after symptom onset. 67% of patients received adrenaline, 85% oral antihistamines, and 89% received IV glucocorticosteroids. 46/100 patients were discharged directly from the ED, of which 87% received further medical prescriptions for self-administration: 67% corticosteroids, 83% antihistamines, and 9% intramuscular adrenaline. 74% were instructed to consult an allergologist for adequate diagnosis. 54/100 patients were hospitalized. CONCLUSION: The majority of patients were treated according to the EAACI guidelines for management of anaphylaxis, but only a minority received the recommended adrenaline auto-injector for self-administration at discharge. Because the majority of patients received medical help later than 30 min after symptom onset, adrenaline auto-injector prescription is a necessity. The low rate of doctors prescribing adrenaline auto-injectors in the ED setting underlines the need to train doctors of various backgrounds in prevention and treatment of anaphylaxis and the close collaboration with allergologists.
Authors: Johannes Ring; Kirsten Beyer; Tilo Biedermann; Andreas Bircher; Matthias Fischer; Thomas Fuchs; Axel Heller; Florian Hoffmann; Isidor Huttegger; Thilo Jakob; Ludger Klimek; Matthias V Kopp; Claudia Kugler; Lars Lange; Oliver Pfaar; Ernst Rietschel; Franziska Rueff; Sabine Schnadt; Roland Seifert; Britta Stöcker; Regina Treudler; Christian Vogelberg; Thomas Werfel; Margitta Worm; Helmut Sitter; Knut Brockow Journal: Allergo J Int Date: 2021-01-28
Authors: Johannes Ring; Kirsten Beyer; Tilo Biedermann; Andreas Bircher; Matthias Fischer; Axel Heller; Isidor Huttegger; Thilo Jakob; Ludger Klimek; Matthias V Kopp; Claudia Kugler; Lars Lange; Oliver Pfaar; Ernst Rietschel; Franziska Rueff; Sabine Schnadt; Roland Seifert; Britta Stöcker; Regina Treudler; Christian Vogelberg; Thomas Werfel; Margitta Worm; Helmut Sitter; Knut Brockow Journal: Allergo J Date: 2021-02-12