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This is the first cross-sectional survey to provide "real-world" data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine.
Dr. Randolph is a member of the Joint Task Force on Practice Parameters, a team of physicians appointed by the American College of Allergy, Asthma & Immunology (ACAAI) and the American Academy of Allergy, Asthma & Immunology (AAAAI) to craft the new ER treatment guidelines. He expects the guidelines will be published in a medical journal this year.
CONCLUSION: Epinephrine by intramuscular injection is a safe therapy for anaphylaxis but training may still be necessary in emergency care settings to minimize drug dosing and administration errors and to allay concerns about its safety.
Significantly higher proportions of patients with anaphylaxis received epinephrine and were admitted to the ED observation unit after introduction of epinephrine autoinjectors and order set implementation. Slightly more than half of the biphasic reactions occurred within the recommended observation time of 4 to 6 hours. Analysis of these data suggests that the multifaceted approach to changing anaphylaxis management described here improved guideline adherence.
Despite the fact that many guidelines are created after systematic reviews and meta-analyses – processes we would never have time to go through ourselves – we, like our own patients, are often noncompliant.
Epinephrine was not administered in almost half of moderate-to-severe cases, and similar numbers of individuals with moderate-to-severe reactions were not prescribed an epinephrine autoinjector.
There is non-adherence to guidelines recommending epinephrine use for all cases of anaphylaxis. We postulate that this may be related to concerns regarding the side effects of epinephrine in adults.
That's why a joint task force of allergists published guidelines on Tuesday in the Annals of Allergy, Asthma and Immunology, reinforcing that emergency rooms should be using epinephrine "first and fast" to treat a severe allergic reaction.
At our recent Annual Scientific Meeting, we convened an anaphylaxis roundtable discussion between emergency room physicians and allergists.
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"Emergency Rooms Often Skip The Epinephrine For Severe Allergies"
[url]http://www.npr.org/blogs/health/2014/12/02/367995894/emergency-rooms-often-skip-the-epinephrine-for-severe-allergies?utm_campaign=storyshare&utm_source=twitter.com&utm_medium=social[/url]QuoteThat's why a joint task force of allergists published guidelines on Tuesday in the Annals of Allergy, Asthma and Immunology, reinforcing that emergency rooms should be using epinephrine "first and fast" to treat a severe allergic reaction.
There are many reasons the article missed the mark about anaphylaxis and its treatment.
Recent evidence from American emergency departments suggests that emergency physicians use epinephrine appropriately in 98% of cases.
Related: Free webinar from FARE on Wednesday, July 15 at 1pm ET. “Emergency Treatment of Anaphylaxis: Trends in Care and Steps to Improve It Among EMS Agencies and Hospitals.”