METHODS: This was a single-center, retrospective, descriptive study that involved reviewing the medical records of patients of any age who met established NIAID/FAAN criteria for ANX during a four-year period at our ED.
RESULTS: By reviewing 1341 charts of potential cases, 60 met the criteria for ANX. Only 23% were correctly diagnosed with ANX. Inappropriate coding was noted in 77%, mainly as an “allergic reaction.” For treatment, whereas systemic corticosteroids were administered to 85% and H1-antihistamines to 73% of patients, only 20% received epinephrine. Of the latter, most of the prescribers were either senior-level residents or faculty members. Ten patients required hospital admission and 50 were discharged home. Among those discharged, prescriptions were given for oral corticosteroids in 64%, H1-antihistamines in 56%, and epinephrine auto-injector in 54%. Allergy evaluation referral was ordered for 8 (16%), but only 4 came for the visit.
CONCLUSIONS: The observed high rate of miscoding ANX and low rates of epinephrine administration, of prescribing epinephrine auto-injectors, and of referral for allergy evaluation, call for more education on these issues in the ED.