Linus B Grabenhenrich1, Sabine Dölle2, Franziska Ruëff3, Jean-Marie Renaudin4, Kathrin Scherer5, Claudia Pföhler6, Regina Treudler7, Alice Koehli8, Vera Mahler9, Thomas Spindler10, Lars Lange11, Maria Beatrice Bilò12, Nikolaos G Papadopoulos13, Jonathan O B Hourihane14, Roland Lang15, Montserrat Fernández-Rivas16, George Christoff17, Ewa Cichocka-Jarosz18, Margitta Worm19. 1. Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany. 2. Department of Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany. 3. Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilian Universität München, Munich, Germany. 4. Allergy Vigilance Network, Vandoeuvre les Nancy, France. 5. Department of Dermatology, Universitätsspital Basel, Basel, Switzerland. 6. Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. 7. Department of Dermatology, Venerology and Allergology, Universitätsmedizin Leipzig, Leipzig, Germany. 8. Division of Allergology, University Children's Hospital Zurich, Zurich, Switzerland. 9. Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany. 10. Klinik für Pädiatrische Pneumologie und Allergologie, Lungenzentrum Süd-West, Wangen im Allgäu, Germany. 11. Department of Pediatrics, St. Marien-Hospital, Bonn, Germany. 12. Department of Internal Medicine/Allergy Unit, University Hospital Ospedali Riuniti, Ancona, Italy. 13. 2nd Pediatric Clinic, Allergy Department, University of Athens, Athens, Greece; Division of Infection, Immunity and Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK. 14. Department of Paediatrics and Child Health, University College Cork, Cork, Ireland. 15. Universitätsklinik für Dermatologie SALK, Paracelsus medizinische Privatuniversität Salzburg, Salzburg, Austria. 16. Allergy Department, Hospital Clinico San Carlos, Madrid, Spain. 17. Allergy Outpatient Clinic, Tokuda Medical Centre Sofia, Sofia, Bulgaria. 18. Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland. 19. Department of Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany. Electronic address: margitta.worm@charite.de.
Abstract
BACKGROUND: Current guidelines recommend intramuscular administration of epinephrine as the first-line drug for the emergency treatment of severe allergic reactions (anaphylaxis), but no randomized trial evidence supports this consensus. OBJECTIVE: We aimed to assess anaphylaxis treatment practices over 10 years, covering several European regions, all allergen sources, and all age groups. METHODS: The European Anaphylaxis Register tracks elicitors, symptoms, emergency treatment, diagnostic workups, and long-term counseling for anaphylaxis incidents through web-based data entry from tertiary allergy specialists, covering information from the emergency respondent, patient, tertiary referral, and laboratory/clinical test results. RESULTS: We analyzed 10,184 anaphylaxis incidents. In total, 27.1% of patients treated by a health professional received epinephrine and, in total, 10.5% received a second dose. Successful administration was less frequent in German-speaking countries (minimum 19.6%) than in Greece, France, and Spain (maximum 66.7%). Over the last decade, epinephrine administration from a health professional almost doubled to reach 30.6% in 2015-2017, half of which was applied intramuscularly. A total of 14.7% of lay- or self-treated cases were treated with an autoinjector. Of those without treatment, 22.4% carried a device for administration. No change in successful administration by lay emergency respondents was found over the last 10 years. Of the reaction and patient characteristics analyzed, only clinical severity considerably influenced the likelihood of receiving epinephrine, with 66.9% of successful administrations in near-fatal (grade IV) reactions. CONCLUSIONS: Despite clear recommendations, only a small proportion of anaphylaxis incidents are treated with epinephrine. We demonstrated a slight increase in treated patients when handled by professionals, but stagnation in lay- or self-treated anaphylaxis. The reaction circumstances, the respondent's professional background, and patient characteristics did not explain which reactions were treated.
BACKGROUND: Current guidelines recommend intramuscular administration of epinephrine as the first-line drug for the emergency treatment of severe allergic reactions (anaphylaxis), but no randomized trial evidence supports this consensus. OBJECTIVE: We aimed to assess anaphylaxis treatment practices over 10 years, covering several European regions, all allergen sources, and all age groups. METHODS: The European Anaphylaxis Register tracks elicitors, symptoms, emergency treatment, diagnostic workups, and long-term counseling for anaphylaxis incidents through web-based data entry from tertiary allergy specialists, covering information from the emergency respondent, patient, tertiary referral, and laboratory/clinical test results. RESULTS: We analyzed 10,184 anaphylaxis incidents. In total, 27.1% of patients treated by a health professional received epinephrine and, in total, 10.5% received a second dose. Successful administration was less frequent in German-speaking countries (minimum 19.6%) than in Greece, France, and Spain (maximum 66.7%). Over the last decade, epinephrine administration from a health professional almost doubled to reach 30.6% in 2015-2017, half of which was applied intramuscularly. A total of 14.7% of lay- or self-treated cases were treated with an autoinjector. Of those without treatment, 22.4% carried a device for administration. No change in successful administration by lay emergency respondents was found over the last 10 years. Of the reaction and patient characteristics analyzed, only clinical severity considerably influenced the likelihood of receiving epinephrine, with 66.9% of successful administrations in near-fatal (grade IV) reactions. CONCLUSIONS: Despite clear recommendations, only a small proportion of anaphylaxis incidents are treated with epinephrine. We demonstrated a slight increase in treated patients when handled by professionals, but stagnation in lay- or self-treated anaphylaxis. The reaction circumstances, the respondent's professional background, and patient characteristics did not explain which reactions were treated.
Authors: Amy Dodd; Anna Hughes; Nicholas Sargant; Andrew F Whyte; Jasmeet Soar; Paul J Turner Journal: Resuscitation Date: 2021-04-23 Impact factor: 5.262
Authors: Montserrat Fernández-Rivas; Ismael Gómez García; Alejandro Gonzalo-Fernández; Manuel Fuentes Ferrer; Sabine Dölle-Bierke; Guadalupe Marco-Martín; Barbara K Ballmer-Weber; Riccardo Asero; Simona Belohlavkova; Kirsten Beyer; Frédéric de Blay; Michael Clausen; Mareen R Datema; Ruta Dubakiene; Kate E C Grimshaw; Karin Hoffmann-Sommergruber; Jonathan O'B Hourihane; Monika Jedrzejczak-Czechowicz; André C Knulst; Tanya Kralimarkova; Thuy-My Le; Nikolaos G Papadopoulos; Todor A Popov; Lars K Poulsen; Ashok Purohit; Suranjith L Seneviratne; Angela Simpson; Atanasios Sinaniotis; Mirjana Turkalji; Sonia Vázquez-Cortés; Rosialzira N Vera-Berrios; Antonella Muraro; Margitta Worm; Graham Roberts; Ronald van Ree; Cristina Fernández-Pérez; Paul J Turner; Elizabeth N Clare Mills Journal: Allergy Date: 2021-11-12 Impact factor: 14.710
Authors: Stefanie Aurich; Sabine Dölle-Bierke; Wojciech Francuzik; Maria Beatrice Bilo; George Christoff; Montserrat Fernandez-Rivas; Thomas Hawranek; Claudia Pföhler; Iwona Poziomkowska-Gȩsicka; Jean-Marie Renaudin; Eva Oppel; Kathrin Scherer; Regina Treudler; Margitta Worm Journal: Front Immunol Date: 2019-04-24 Impact factor: 7.561