Treatment of Anaphylaxis: Are We Doing It Right?
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Andrea Blackman, MD, Sara Anvari, MD, MSc, Aikaterini Anagnostou, MD MSc PhD
RATIONALE: Anaphylaxis is a severe, life-threatening, systemic hypersensitivity reaction. We examined availability of epinephrine auto-injectors at the time of reaction and use of epinephrine as a first-line treatment for anaphylaxis. Furthermore, initial symptom presentation, the time for a caregiver to initiate treatment, along with the rate of biphasic reactions and hospitalizations were evaluated.

METHODS: We performed a retrospective case-note review between January-December 2016 for children 0-18 years old, presenting with anaphylaxis. We report results on the first 116 patients.

RESULTS: Among the first 116 children (4 months-16 years; median age:7years) presenting with anaphylaxis, 39 (34%) patients had epinephrine available at the time of their reaction; epinephrine was the first-line treatment for anaphylaxis in 61 (53%) patients, whereas antihistamines were used as first-line treatment in 47 (41%) and inhalers in 4 (3%). Cutaneous findings were observed as an initial presentation in 78 (67%) patients, whereas respiratory symptoms presented initially in 34 (29%) patients, gastrointestinal symptoms in 2 (2%) and cardiovascular symptoms in 1 (1%) patient. Treatment was delayed (>/=15min) in 47 (41%) patients. Biphasic reactions were observed in 21 (18%) patients and 20 (17%) patients required overnight hospitalization to manage their anaphylaxis.

CONCLUSIONS: Despite national and international recommendations to administer epinephrine as a first-line treatment for anaphylaxis, many parents continue to manage anaphylaxis with initial administration of antihistamines. Furthermore, only one-third of patients had an epinephrine auto-injector available at the time of their reaction, in our cohort. These findings highlight the importance of repeated and consistent anaphylaxis education for both patients and families.