Anaphylaxis management in a French pediatric emergency department: Lessons from the ANA-PED study

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy Pub Date : 2023-08-01 DOI:10.1002/clt2.12289

Evangéline Clark, Luciana Kase Tanno, Tram Vo, Brigitte Blanc, Pascal Demoly, Davide Caimmi

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引用次数: 0

Abstract

Background

Anaphylaxis is a serious systemic hypersensitivity reaction that requires immediate recognition and prompt administration of epinephrine/adrenaline. The present study aimed to assess the appropriateness of epinephrine/adrenaline use in children identified as allergic by physicians in the emergency department (ED) at the time of the reaction, and to identify factors that are possibly associated with epinephrine/adrenaline administration, auto-injector prescription, and further referral to an allergist.

Methods

We performed a retrospective cross-sectional study at the pediatric ED of the University Hospital of Montpellier, France. We included all consecutive children who attended the ED between 2016 and 2020 with an allergy-related diagnosis at discharge.

Results

We included 1056 allergy-related visits, including 224 (21.2%) with a diagnosis of anaphylaxis at discharge; only 17.0% of them received an epinephrine/adrenaline injection, and 57.1% consulted an allergist after the acute episode. An auto-injector was prescribed to 63 (28.1%) patients at discharge from the ED. Besides the severity of the clinical presentation, factors associated with a guidelines-based management of the anaphylactic reaction and with an increased administration rate of epinephrine/adrenaline included presence of asthma symptoms and presence of extended skin reactions.

Conclusions

Our study underlines persistent gaps in the management of pediatric anaphylaxis in ED, focusing on hereby identified levers. By disseminating current knowledge and guidelines on anaphylaxis and allergies, specialists could work together with emergency physicians to establish effective management algorithms and improve anaphylaxis management and care pathways for children experiencing allergic reactions, especially anaphylaxis.

Trail Registration

Clinical Trials, number NCT05112367.

Abstract Image

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法国儿科急诊科的过敏反应管理:来自ANA-PED研究的经验教训

背景:过敏反应是一种严重的全身性超敏反应，需要立即识别并及时给予肾上腺素。本研究旨在评估急诊科(ED)医生在反应发生时确定为过敏的儿童使用肾上腺素/肾上腺素的适当性，并确定可能与肾上腺素/肾上腺素给药、自动注射器处方和进一步转介给过敏专科医生相关的因素。方法:我们在法国蒙彼利埃大学医院儿科急诊科进行回顾性横断面研究。我们纳入了所有在2016年至2020年期间连续就诊且出院时诊断为过敏相关的儿童。结果我们纳入了1056例过敏相关就诊，其中224例(21.2%)在出院时诊断为过敏反应;只有17.0%的人接受了肾上腺素/肾上腺素注射，57.1%的人在急性发作后咨询了过敏症专科医生。63例(28.1%)患者从急诊科出院时使用了自动注射器。除了临床表现的严重程度外，与基于指南的过敏反应管理和肾上腺素/肾上腺素给药率增加相关的因素包括哮喘症状和皮肤反应的存在。结论:我们的研究强调了ED儿童过敏反应管理的持续差距，重点是在此确定的杠杆。通过传播关于过敏反应和过敏反应的最新知识和指南，专家可以与急诊医生一起建立有效的管理算法，改善过敏反应儿童的过敏反应管理和护理途径，特别是过敏反应。临床试验注册，编号NCT05112367。

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来源期刊

Clinical and Translational Allergy Immunology and Microbiology-Immunology

CiteScore

7.50

自引率

4.50%

发文量

117

审稿时长

12 weeks

期刊介绍： Clinical and Translational Allergy, one of several journals in the portfolio of the European Academy of Allergy and Clinical Immunology, provides a platform for the dissemination of allergy research and reviews, as well as EAACI position papers, task force reports and guidelines, amongst an international scientific audience. Clinical and Translational Allergy accepts clinical and translational research in the following areas and other related topics: asthma, rhinitis, rhinosinusitis, drug hypersensitivity, allergic conjunctivitis, allergic skin diseases, atopic eczema, urticaria, angioedema, venom hypersensitivity, anaphylaxis, food allergy, immunotherapy, immune modulators and biologics, animal models of allergic disease, immune mechanisms, or any other topic related to allergic disease.

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