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problem among both healthcare professionals and patients
My partner in practice once had a patient in the emergency department for hours getting fluids for hypotension (blood pressure, 80/50 mm Hg), along with antihistamines and corticosteroids as anaphylaxis management. The patient was concerned and called my partner in the middle of the night. The treating emergency physician refused to give epinephrine and challenged my partner to come in if he wanted to manage the case—which he in fact did, and the patient promptly responded to a single intramuscular dose of 0.3 mg (1:1000) epinephrine.
“In adults, our study indicates that almost 50 percent of severe reactions are not treated with epinephrine in or outside of the hospital,” says Dr. Moshe Ben-Shoshan, a pediatric allergist at Montreal Children’s Hospital and a key researcher behind the Cross-Canada Anaphylaxis Registry.
Still, the caregivers, whether day care workers or parents, are only part of the problem. What about those EMS personnel? What about the emergency rooms, where the doctors operate by a different set of protocols and define anaphylaxis differently?