Article
Anesthesiology
Yuki Suigiyama, Tomonori Takazawa, Natsuko Watanabe, Kiyoko Bito, Tetsuhiro Fujiyoshi, Shinsuke Hamaguchi, Takashi Haraguchi, Tatsuo Horiuchi, Yoshinori Kamiya, Noboru Maruyama, Hitoshi Masumo, Harumasa Nakazawa, Kazuhiro Nagumo, Masaki Orihara, Jun Sato, Kenichi Sekimoto, Kenichiro Takahashi, Mutsumi Uchiyama, Kazunobu Takahashi, Masao Yamaguchi, Mikito Kawamata
Summary: Diagnosis of perioperative anaphylaxis is challenging due to its non-specific and variable symptoms. The choice of therapeutic agents and anaesthesiologist responses can vary, potentially affecting outcomes. Limited research has focused on these factors.
BRITISH JOURNAL OF ANAESTHESIA
(2023)
Review
Allergy
Nandinee Patel, Kok Wee Chong, Alexander Y. G. Yip, Despo Ierodiakonou, Joan Bartra, Robert J. Boyle, Paul J. Turner
Summary: The study revealed that around 1 in 10 anaphylaxis reactions require multiple doses of epinephrine for treatment, with a higher proportion treated with multiple doses by healthcare professionals.
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
(2021)
Article
Medicine, General & Internal
Lily Myung-Jin Cha, Won Seok Lee, Man Yong Han, Kyung Suk Lee
Summary: This study investigated the factors influencing the timely use of epinephrine in pediatric anaphylaxis cases. The results showed that wheezing symptoms, history of asthma, age, food triggers, and food allergen sensitivity were significant factors affecting the rapid administration of epinephrine.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Emergency Medicine
Michelle A. Murata, Loren G. Yamamoto
Summary: The study found that only 25.3% of patients with peanut allergies administered epinephrine on-scene, with females more likely to receive epinephrine than males. The rate of epinephrine administration increased over time. Comfort with epinephrine auto-injectors among healthcare professionals facilitated willingness to administer on-scene, highlighting the importance of training strategies for all individuals prescribed epinephrine.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Review
Allergy
Laura May Miles, Kayadri Ratnarajah, Sofianne Gabrielli, Elissa M. Abrams, Jennifer L. P. Protudjer, Philippe Begin, Edmond S. Chan, Julia Upton, Susan Waserman, Wade Watson, Jennifer Gerdts, Moshe Ben-Shoshan
Summary: The study found that prompt use of epinephrine in cases of anaphylaxis remains suboptimal globally. Major barriers include low prescription rates of epinephrine autoinjectors and lack of stock epinephrine in schools. Various studies have shown effective methods to promote adequate and timely use of epinephrine.
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
(2021)
Article
Emergency Medicine
Daniel Chiang, Justine M. Ade, Xiao-Wei Liu, Fernanda Bellolio, Christine M. Lohse, Benjamin J. Sandefur, Ronna L. Campbell
Summary: This study investigated the triage of anaphylaxis patients in the emergency department based on Emergency Severity Index (ESI). Patients assigned to lower ESI levels experienced delays in epinephrine administration. Skin-related chief concerns were more likely to be triaged to lower acuity ESI levels. Further research is needed to identify interventions that can improve ED anaphylaxis triage.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Review
Allergy
Debra de Silva, Chris Singh, Antonella Muraro, Margitta Worm, Cherry Alviani, Victoria Cardona, Audrey DunnGlvin, Lene Heise Garvey, Carmen Riggioni, Elizabeth Angier, Stefania Arasi, Abdelouahab Bellou, Kirsten Beyer, Diola Bijlhout, M. Beatrice Bilo, Knut Brockow, Montserrat Fernandez-Rivas, Susanne Halken, Britt Jensen, Ekaterina Khaleva, Louise J. Michaelis, Hanneke Oude Elberink, Lynne Regent, Angel Sanchez, Berber Vlieg-Boerstra, Graham Roberts
Summary: This systematic review found limited and uncertain evidence on the diagnosis, management, and prevention strategies of anaphylaxis. Adrenaline is commonly used for emergency management, but robust research on its effectiveness is lacking.
Article
Emergency Medicine
William C. Sokoloff, Nicole C. O'Connell, Prasra G. Olson, Daniel M. Fein
Summary: The study aimed to determine the prescription filling rate and accessibility of self-injectable epinephrine devices among families discharged from the Pediatric ED. Results showed that while the majority of patients filled their prescriptions, less than half had accessible unexpired devices.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Article
Allergy
Timothy E. Dribin, Susan Waserman, Paul J. Turner
Summary: International guidelines recommend intramuscular epinephrine as the first-line treatment for anaphylaxis, and the availability of epinephrine autoinjectors has facilitated its administration in community settings. However, there are uncertainties regarding the usage of epinephrine, such as variations in prescribing autoinjectors, when to administer epinephrine, the need to contact emergency medical services, and the impact of epinephrine on mortality and quality of life. A poor response to epinephrine after 2 doses may indicate severity and the need for urgent escalation, but more research is needed to confirm the safety of not activating emergency medical services in patients who respond to a single dose. Patients at risk of anaphylaxis should be cautioned against relying solely on autoinjectors.
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
(2023)
Article
Allergy
Thomas B. Casale, Julie Wang, John Oppenheimer, Anna Nowak-Wegrzyn
Summary: The appropriate at-home management of anaphylaxis begins with patient education on recognition and treatment, especially when and how to use epinephrine. Delayed administration of epinephrine as well as having severe symptoms and needing multiple doses of epinephrine to treat symptoms are risk factors for biphasic anaphylaxis. The successful implementation of at-home management of anaphylaxis requires appropriate patient selection and an algorithmic approach that recommends activation of emergency medical services (EMS) when the patient does not adequately respond to at-home administration of epinephrine or there are extenuating patient-related circumstances. Fortunately, approximately 98% of anaphylactic episodes respond to 2 or fewer doses of epinephrine, the standard prescription used for epinephrine autoinjectors; fatal anaphylaxis is very rare, as low as 0.002 deaths/million person-years; and biphasic reactions are uncommon (similar to 5%), and only extremely rarely lethal. Thus, most common concerns leading to recommended EMS activation and emergency department visits after epinephrine administration are generally unsubstantiated. Furthermore, emergency department visits do not always lead to better treatment and drive health care costs higher. Open communications with patients and families regarding risks and benefits of at-home management and observation versus EMS activation and emergency department evaluation after epinephrine administration for anaphylaxis are essential. However, we believe the data indicate that it is time to reconsider the often used and taught approach that recommends EMS activation whenever epinephrine is used.
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
(2022)
Article
Food Science & Technology
Dimitris Efthymiou, Persefoni Panayi, Gavriela Feketea, Constantinos Pitsios, Ioana Adriana Muntean, Emilia Vassilopoulou
Summary: The study evaluated allergy management competences in primary schools in Cyprus and found that most schools did not meet safety standards in coping with allergic reactions in children with food allergies, including the availability and training in using epinephrine auto-injectors.
Article
Pharmacology & Pharmacy
N. Cambaz Kurt, N. O. Kutlu
Summary: This study aimed to assess the knowledge of pediatricians in Turkey regarding the recognition and treatment of anaphylaxis. The results showed an increasing trend in the level of awareness of anaphylaxis in Turkey over time. However, there are still deficiencies in diagnosing and treating anaphylaxis, especially for physicians working in rural areas of developing countries.
EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES
(2023)
Review
Allergy
Annette Carlisle, Jay Lieberman
Summary: Infant anaphylaxis, although relatively rare, poses unique diagnostic challenges and treatment considerations, with non-classical signs like ear pulling and tongue thrusting complicating the diagnosis. Special considerations for treating infant anaphylaxis include appropriate needle length, dosage based on infant weight, and availability of different epinephrine auto-injectors.
JOURNAL OF ASTHMA AND ALLERGY
(2021)
Article
Emergency Medicine
Brit Long, Michael Gottlieb
Summary: Anaphylaxis is a potentially deadly condition that requires emergent therapy. Recent evidence updates may improve the diagnosis and management of this condition. Emergency clinicians need to be aware of current updates in the evaluation and management of anaphylaxis.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Article
Pediatrics
Arianna Dondi, Elisabetta Calamelli, Sara Scarpini, Egidio Candela, Giovanni Battista Biserni, Chiara Ghizzi, Francesca Lombardi, Paola Salvago, Laura Serra, Ilaria Corsini, Marcello Lanari
Summary: This study aimed to evaluate the factors that play a significant role in the correct diagnosis and appropriate treatment of anaphylaxis in pediatric emergency departments. The results showed that anaphylaxis is still under-recognized and under-treated. Active symptoms, triage coding, and upper airway involvement were found to favor a correct diagnosis, and epinephrine was more likely to be administered to patients with a confirmed diagnosis of anaphylaxis and cardiovascular, respiratory, or persistent gastrointestinal symptoms.
