1
|
Ehrhard S, Gautschi D, Eyb V, Schauber SK, Ricklin ME, Klukowska-Rötzler J, Exadaktylos AK, Helbling A. Use of epinephrine in anaphylaxis: a retrospective cohort study at a Swiss university emergency department. Swiss Med Wkly 2023; 153:40065. [PMID: 36971665 DOI: 10.57187/smw.2023.40065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
AIMS OF THE STUDY Anaphylaxis is a medical emergency and requires prompt treatment to prevent life-threatening conditions. Epinephrine, considered as the first-line drug, is often not administered. We aimed first to analyse the use of epinephrine in patients with anaphylaxis in the emergency department of a university hospital and secondly to identify factors that influence the use of epinephrine. METHODS We performed a retrospective analysis of all patients admitted with moderate or severe anaphylaxis to the emergency department between 1 January 2013 and 31 December 2018. Patient characteristics and treatment information were extracted from the electronic medical database of the emergency department. RESULTS A total of 531 (0.2%) patients with moderate or severe anaphylaxis out of 260,485 patients admitted to the emergency department were included. Epinephrine was administered in 252 patients (47.3%). In a multivariate logistic regression, cardiovascular (Odds Ratio [OR] = 2.94, CI 1.96-4.46, p <0.001) and respiratory symptoms (OR = 3.14, CI 1.95-5.14, p<0.001) were associated with increased likelihood of epinephrine administration, in contrast to integumentary symptoms (OR = 0.98, CI 0.54-1.81, p = 0.961) and gastrointestinal symptoms (OR = 0.62, CI 0.39-1.00, p = 0.053). CONCLUSIONS Less than half of the patients with moderate and severe anaphylaxis received epinephrine according to guidelines. In particular, gastrointestinal symptoms seem to be misrecognised as serious symptoms of anaphylaxis. Training of the emergency medical services and emergency department medical staff and further awareness are crucial to increase the administration rate of epinephrine in anaphylaxis.
Collapse
Affiliation(s)
- Simone Ehrhard
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominic Gautschi
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vicky Eyb
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan K Schauber
- Centre for Health Science Education, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Meret E Ricklin
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arthur Helbling
- Division of Allergology and Clinical Immunology, Department of Pulmonary Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
2
|
Salman M, Mustafa ZU, Shehzadi N, Mallhi TH, Asif N, Khan YH, Khan TM, Hussain K. Evaluation of knowledge and practices about administration and regulations of high alert medications among hospital pharmacists in Pakistan: findings and implications. Curr Med Res Opin 2022; 38:1967-1975. [PMID: 36111419 DOI: 10.1080/03007995.2022.2124063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A death of a nine months old child in Pakistan following the rapid administration of potassium chloride raised serious concerns on the awareness of appropriate use of high alert medications (HAMs) among healthcare professionals (HCPs). This study aimed to ascertain HAMs-related knowledge among hospital pharmacists in Pakistan. METHODOLOGY A cross-sectional study using exponential non-discriminative snowball sampling was conducted among hospital pharmacists in healthcare settings in Punjab, Pakistan. A validated study tool was used to determine knowledge on administration, regulation, and practices related to the HAMs. Barriers to conducting HAMs training in the hospitals were assessed from an open-ended question. All quantitative data were analyzed using SPSS 22.0 while the content analysis was performed on the qualitative data. RESULTS A total of 202 hospital pharmacists were included in the study. The mean knowledge score for HAMs administration and regulation were 5.86 ± 1.89 (95% CI 5.60-6.12) and 7.25 ± 1.70 (95% CI 7.02-7.49), respectively. Approximately half of the respondents (49.5%) achieved scores ≥ 70%, demonstrating sufficient knowledge of HAMs. In the multivariable-adjusted model, increasing age and work experience were found to be the positive predictors of good HAMs knowledge. The mean practice score was 36.42 ± 1.97 (95% CI 34.05-38.77), with 62.4% of pharmacists following good HAMs-related practices. We identified several barriers to conducting HAMs training through qualitative analysis. These barriers included lack of knowledge, poor attitude and behavior of medical and paramedical staff, false beliefs, lack of active support by hospital administration, lack of cooperation between HCPs, lack of opportunities, heavy workload, insufficient human resources, financial constraints, and lack of motivation. CONCLUSIONS A significant proportion of the hospital pharmacists had unsatisfactory knowledge and practices of HAMs. These findings underscore that training on HAMs should be conducted periodically as a part of hospital-based pharmacy education to maximize drug safety.
Collapse
Affiliation(s)
- Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter Hospital, Pakpattan, Pakistan
| | - Naureen Shehzadi
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Noman Asif
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Science, University of Veterinary and Animal Science, City Campus, Outfall Road Civil line Lahore, Lahore, Pakistan
| | - Khalid Hussain
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| |
Collapse
|
3
|
Seo Y, Ahn T, Paik J, Kang S. Should steroids be used for anaphylaxis after the COVID-19 vaccine? Clin Exp Emerg Med 2022; 8:251-254. [PMID: 35000352 PMCID: PMC8743684 DOI: 10.15441/ceem.21.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Youngho Seo
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Taekyu Ahn
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jinhui Paik
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Soo Kang
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
4
|
Abstract
Anaphylaxis is an acute, potentially fatal systemic allergic reaction with varied mechanisms and clinical presentations. Although prompt recognition and treatment of anaphylaxis are imperative, both patients and healthcare professionals often fail to recognize and diagnose early signs and symptoms of the condition. Clinical manifestations vary widely; however, the most common signs are cutaneous symptoms, including urticaria, angioedema, erythema and pruritus. Immediate intramuscular administration of epinephrine into the anterolateral thigh is first-line therapy, even if the diagnosis is uncertain. The mainstays of long-term management include specialist assessment, avoidance measures, and the provision of an epinephrine auto-injector and an individualized anaphylaxis action plan. This article provides an overview of the causes, clinical features, diagnosis and acute and long-term management of this serious allergic reaction.
Collapse
Affiliation(s)
| | | | | | - Harold Kim
- 1Western University, London, ON Canada.,4McMaster University, Hamilton, ON Canada
| |
Collapse
|
5
|
Abstract
Anaphylaxis is a severe and potentially life-threatening allergic reaction. There are numerous potential causes, with food allergy being the leading cause in children and the focus of this review. Most reactions involve an IgE-mediated mechanism, although non-IgE-mediated and nonimmunologic reactions can occur. Various cofactors to be discussed can place certain individuals at an increased risk of severe or fatal anaphylaxis. The clinical manifestations of anaphylaxis are broad and may involve multiple body systems. Diagnosis of food-related anaphylaxis is primarily based on signs and symptoms and supported, wherever possible, by identification and confirmation of a culprit food allergen. First-line treatment of anaphylaxis is intramuscular administration of epinephrine. Long-term management is generally focused on strict allergen avoidance and more recently on food desensitization using immunotherapy. This review provides an overview of anaphylaxis with a specific focus on food allergy.
Collapse
Affiliation(s)
- David Yue
- Division of Clinical Immunology & Allergy, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, ON, Canada
| | - Amanda Ciccolini
- Division of Clinical Immunology & Allergy, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, ON, Canada
| | - Ernie Avilla
- Division of Clinical Immunology & Allergy, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, ON, Canada
| | - Susan Waserman
- Division of Clinical Immunology & Allergy, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Alvarez-Perea A, Tanno LK, Baeza ML. How to manage anaphylaxis in primary care. Clin Transl Allergy 2017; 7:45. [PMID: 29238519 PMCID: PMC5724339 DOI: 10.1186/s13601-017-0182-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/16/2017] [Indexed: 12/13/2022] Open
Abstract
Anaphylaxis is defined as a severe life-threatening generalized or systemic hypersensitivity reaction characterized by rapidly developing airway and/or circulation problems. It presents with very different combinations of symptoms and apparently mild signs and can progress to fatal anaphylactic shock unpredictably. The difficulty in recognizing anaphylaxis is due, in part, to the variability of diagnostic criteria, which in turn leads to a delay in administration of appropriate treatment, thus increasing the risk of death. The use of validated clinical criteria can facilitate the diagnosis of anaphylaxis. Intramuscular epinephrine (adrenaline) is the medication of choice for the emergency treatment of anaphylaxis. Administration of corticosteroids and H1-antihistamines should not delay the administration of epinephrine, and the management of a patient with anaphylaxis should not end with the acute episode. Long-term management of anaphylaxis should include avoidance of triggers, following confirmation by an allergology study. Etiologic factors suspected in the emergency department often differ from the real causes of anaphylaxis. Evaluation of patients with a history of anaphylaxis should also include an assessment of personal data, such as age and comorbidities, which may increase the risk of severe reactions. Special attention should also be paid to co-factors, as these may easily confound the cause of the anaphylaxis. Patients experiencing anaphylaxis should administer epinephrine as soon as possible. Education (including the use of Internet and social media), written personalized emergency action plans, and self-injectable epinephrine have proven useful for the treatment of further anaphylaxis episodes.
Collapse
Affiliation(s)
- Alberto Alvarez-Perea
- Allergy Service, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007 Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, France
- Pierre and Marie Curie Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
| | - María L. Baeza
- Allergy Service, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007 Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Biomedical Research Network on Rare Diseases (CIBERER)-U761, Madrid, Spain
| |
Collapse
|
7
|
Lee AY, Enarson P, Clarke AE, La Vieille S, Eisman H, Chan ES, Mill C, Joseph L, Ben-Shoshan M. Anaphylaxis across two Canadian pediatric centers: evaluating management disparities. J Asthma Allergy 2016; 10:1-7. [PMID: 28115856 PMCID: PMC5221795 DOI: 10.2147/jaa.s123053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are no data on the percentage of visits due to anaphylaxis in the emergency department (ED), triggers, and management of anaphylaxis across different provinces in Canada. OBJECTIVE To compare the percentage of anaphylaxis cases among all ED visits, as well as the triggers and management of anaphylaxis between two Canadian pediatric EDs (PEDs). METHODS As part of the Cross-Canada Anaphylaxis Registry (C-CARE), children presenting to the British Columbia Children's Hospital (BCCH) and Montreal Children's Hospital (MCH) EDs with anaphylaxis were recruited. Characteristics, triggers, and management of anaphylaxis were documented using a standardized data entry form. Differences in demographics, triggers, and management were determined by comparing the difference of proportions and 95% confidence interval. RESULTS Between June 2014 and June 2016, there were 346 visits due to anaphylaxis among 93,730 PED visits at the BCCH ED and 631 anaphylaxis visits among 164,669 pediatric visits at the MCH ED. In both centers, the majority of cases were triggered by food (BCCH 91.3% [88.7, 94.0], MCH 82.4% [79.7, 85.3]), of which peanuts were the most common culprit (24.7% [20.9, 29.9] and 19.0% [15.8, 22.7], respectively). Pre-hospital administration of epinephrine (BCCH 27.7% [23.2, 32.8], MCH 33.1% [29.5, 37.0]) and antihistamines (BCCH 50.6% [45.2, 56.0], MCH 47.1% [43.1, 51.0]) was similar. In-hospital management differed in terms of increased epinephrine, antihistamine, and steroid use at the BCCH (59.2% [53.9, 64.4], 59.8% [54.4, 65.0], and 60.1% [54.7, 65.3], respectively) compared to the MCH (42.2% [38.3, 46.2], 36.2% [32.5, 40.1], and 11.9% [9.5, 14.8], respectively). Despite differences in management, percentage of cases admitted to the intensive care unit was similar between the two centers. CONCLUSION Compared to previous European and North American reports, there is a high percentage of anaphylaxis cases in two PEDs across Canada with substantial differences in hospital management practices. It is crucial to develop training programs that aim to increase epinephrine use in anaphylaxis.
Collapse
Affiliation(s)
- Alison Ym Lee
- Pediatric Residency Program, Department of Pediatrics, University of British Columbia, BC Children's Hospital
| | - Paul Enarson
- Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | | | - Harley Eisman
- Emergency Department; Department of Pediatrics, Montreal Children's Hospital, Montreal, QC
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC
| | - Christopher Mill
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| |
Collapse
|
8
|
Saleh-Langenberg J, Dubois AEJ, Groenhof F, Kocks JWH, van der Molen T, Flokstra-de Blok BMJ. Epinephrine auto-injector prescriptions to food-allergic patients in primary care in The Netherlands. Allergy Asthma Clin Immunol 2015; 11:28. [PMID: 26472961 PMCID: PMC4607246 DOI: 10.1186/s13223-015-0094-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/23/2015] [Indexed: 01/22/2023] Open
Abstract
Background The knowledge of general practitioner(s) (GPs) regarding food allergy and anaphylaxis and practices in the prescription of epinephrine auto-injector(s) (EAIs) among GPs has previously only been studied using questionnaires and hypothetical cases. Therefore, there are currently no data as to whether or not GPs prescribe EAIs to high risk food-allergic patients presenting to primary care practices. The aim of this study was therefore to describe and evaluate practice in EAI prescription by GPs to food-allergic patients in The Netherlands. Methods Patients aged 12–23 years who consulted their GP for allergic symptoms were identified in a primary care database. Patients were classified as probably or unlikely to be food-allergic. A risk factor assessment was done to identify probably food-allergic patients at high risk for anaphylaxis to assess the need for an EAI. Results One hundred forty-eight out of 1015 patients consulted their GP for allergic symptoms due to food. Eighty patients were excluded from analysis because of incomplete records. Thirty-four patients were classified as probably food-allergic. Twenty-seven of them were considered high risk patients and candidates for an EAI. Importantly, only 10 of them had actually been prescribed an EAI by their GP. Conclusions This study shows that high risk food-allergic patients that visit their GPs are often not prescribed an EAI. Thus, previously identified low rates of EAI ownership may be partly due to GPs not prescribing this medication to patients for whom it would be appropriate to do so. These data suggest that there is a need for improvement of the quality of care for high risk food-allergic patients in primary care.
Collapse
Affiliation(s)
- Jacquelien Saleh-Langenberg
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands ; GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands ; GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - F Groenhof
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - J W H Kocks
- GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands ; Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - T van der Molen
- GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands ; Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - B M J Flokstra-de Blok
- GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands ; Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| |
Collapse
|
9
|
Nath P, Basher A, Harada M, Sarkar S, Selim S, Maude RJ, Noiri E, Faiz A. Immediate hypersensitivity reaction following liposomal amphotericin-B (AmBisome) infusion. Trop Doct 2014; 44:241-2. [PMID: 25139411 PMCID: PMC4232346 DOI: 10.1177/0049475514543655] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Liposomal amphotericin-B (AmBisome) is now becoming first choice for the treatment of visceral leishmaniasis (kala-azar) patients due to high efficacy and less toxicity. The reported incidence of hypersensitivity reactions to liposomal amphotericin-B (AmBisome), especially during therapy, is very rare. We report two patients with kala-azar: one developed breathing difficulties and hypotension followed by shock and the other had facial angioedema with chest tightness during treatment. Both patients were managed with immediate action of injection: adrenaline, diphenhydramine and hydrocortisone. In our experience, AmBisome can cause severe hypersensitivity reactions that warrant proper support and close supervision.
Collapse
Affiliation(s)
- Proggananda Nath
- Medical Officer, Surya Kanta Kala-azar Research Centre, Mymensingh Medical College Hospital, Bangladesh
| | - Ariful Basher
- Registrar & Incharge, Department of Infectious and Tropical Diseases, Mymensingh Medical College Hospital, Bangladesh
| | - Michiyo Harada
- Research Fellow, Department of Hemodialysis & Apheresis, The University of Tokyo Hospital, Japan
| | - Santana Sarkar
- Medical Officer, Surya Kanta Kala-azar Research Centre, Mymensingh Medical College Hospital, Bangladesh
| | - Shahjada Selim
- Registrar, Department of Medicine, Shaheed Suhrawardy Medical College Hospital, Bangladesh
| | - Richard J Maude
- Senior Clinical Research Fellow, Mahidol-Oxford Tropical Medicine Research Unit, Thailand Senior Clinical Research Fellow and Honorary Consultant Physician, Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, UK
| | - Eisei Noiri
- Associate Professor, Department of Hemodialysis & Apheresis, The University of Tokyo Hospital, Japan
| | - Abul Faiz
- Professor and Director General of Health Services (Retired), Bangladesh
| |
Collapse
|
10
|
Rubin T, Clayton J, Adams D, Jou H, Vohra S. Systematic review of outcome measures in trials of pediatric anaphylaxis treatment. BMC Pediatr 2014; 14:158. [PMID: 24950840 PMCID: PMC4088301 DOI: 10.1186/1471-2431-14-158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 03/27/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Considerable heterogeneity has been observed in the selection and reporting of disease-specific pediatric outcome measures in randomized controlled trials (RCTs). This makes interpretation of results and comparison across trials challenging. Outcome measures in pediatric anaphylaxis trials have never previously been systematically assessed. This systematic review (SR) identified and assessed outcome measures used in RCTs of anaphylaxis treatment in children. As a secondary objective, this SR assessed the evidence for current treatment modalities for anaphylaxis in the pediatric population. METHODS We searched MEDLINE, EMBASE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL from 2001 until December 2012. We also searched websites listing ongoing trials. We included randomized and controlled trials of anaphylaxis treatment in patients 0-18 years of age. Two authors independently assessed articles for inclusion. RESULTS No published studies fulfilled the inclusion criteria. CONCLUSIONS There is an alarming absence of RCTs evaluating the treatments for anaphylaxis in children. High quality studies are needed and are possible to design, despite the severe and acute nature of this condition. Consensus about the selection and validation of appropriate outcome measures will enhance the quality of research and improve the care of children with anaphylaxis. TRIAL REGISTRATION CRD42012002685.
Collapse
Affiliation(s)
- Tamar Rubin
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | | | - Denise Adams
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- CARE Program, University of Alberta, Edmonton, Canada
| | - Hsing Jou
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- CARE Program, University of Alberta, Edmonton, Canada
| | - Sunita Vohra
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- CARE Program, University of Alberta, Edmonton, Canada
- Department of Public Health Sciences, University of Alberta, Edmonton, Canada
| |
Collapse
|
11
|
Abstract
Anaphylaxis is an acute, potentially fatal systemic reaction with varied mechanisms and clinical presentations. Although prompt recognition and treatment of anaphylaxis are imperative, both patients and healthcare professionals often fail to recognize and diagnose early signs and symptoms of the condition. Clinical manifestations vary widely, however, the most common signs are cutaneous symptoms, including angioedema, urticaria, erythema and pruritus. Immediate intramuscular administration of epinephrine into the lateral thigh is first-line therapy, even if the diagnosis is uncertain. The mainstays of long-term management include specialist assessment, avoidance measures, and the provision of an epinephrine auto-injector and an individualized anaphylaxis action plan. This article provides an overview of the causes, clinical features, diagnosis and acute and long-term management of this serious allergic reaction.
Collapse
Affiliation(s)
- Harold Kim
- University of Western Ontario, London, Ontario, Canada.
| | | |
Collapse
|