SHIFTING PERSPECTIVES: DIPHENHYDRAMINE USAGE IN ANAPHYLAXIS AND URTICARIA ACROSS UNITED STATES EMERGENCY DEPARTMENTS

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology Pub Date : 2024-10-25 DOI:10.1016/j.anai.2024.08.061

J. Ifikhar, D. Sparks, A. Hendrix-Dicken, M. Hartwell, M. Condren

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引用次数: 0

Abstract

Introduction

In recent years, there has been a notable shift in the medical community's perspective regarding the use of diphenhydramine for allergic reactions, specifically for urticaria and anaphylaxis, stemming from its side effect profile and superior efficacy of second-generation antihistamines. Notably, the AAAAI's updated 2020 anaphylaxis guidelines recommended against use of first-generation antihistamines in the acute phase or to prevent biphasic reactions. Our study aimed to assess diphenhydramine utilization in US emergency departments (EDs) for anaphylaxis and urticaria from 2019 to 2021.

Methods

We conducted a cross-sectional study using data from the 2019-2021 National Hospital Ambulatory Medical Care Survey (NHAMCS) for patient visits to emergency departments. We analyzed individuals with ICD-10 codes for anaphylaxis (T78) and/or urticaria (L50) who received at least one medication. The NHAMCS is conducted by the CDC and includes demographics, reasons for visits, diagnoses, treatments, and outcomes. Significance was determined using design-based Pearson chi-square with P<0.050.

Results

Of 450 anaphylaxis and/or urticaria cases, 276 involved diphenhydramine use which after sampling weights were applied represented 62.0% of cases. Diphenhydramine administration rates were 58.0% for anaphylaxis alone, 69.5% for urticaria alone, and 73.4% for individuals presenting with both conditions. No significant change in diphenhydramine use was observed from 2019 to 2021 (P=0.9421).

Conclusion

Despite emerging evidence and evolving clinical guidelines regarding diphenhydramine use, our findings suggest no discernible changes in ED practices post-AAAAI updates. Moving forward, bridging this gap between evidence-based guidelines and clinical practice is imperative for enhancing patient care and ensuring adherence of evolving standards in urticaria and anaphylaxis management.

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转变视角：美国急诊科在过敏性休克和荨麻疹中使用苯海拉明的情况

导言近年来，由于苯海拉明的副作用和第二代抗组胺药的卓越疗效，医学界对使用苯海拉明治疗过敏反应（尤其是荨麻疹和过敏性休克）的观点发生了明显转变。值得注意的是，美国过敏性休克协会（AAAAI）更新的2020年过敏性休克指南建议在急性期或预防双相反应时不要使用第一代抗组胺药。我们的研究旨在评估2019年至2021年美国急诊科（ED）对过敏性休克和荨麻疹使用苯海拉明的情况。方法我们利用2019年至2021年全国医院非住院医疗护理调查（NHAMCS）中急诊科就诊患者的数据进行了一项横断面研究。我们分析了ICD-10编码为过敏性休克（T78）和/或荨麻疹（L50）且至少接受过一次药物治疗的患者。NHAMCS 由美国疾病预防控制中心（CDC）实施，包括人口统计学、就诊原因、诊断、治疗和结果。结果在 450 例过敏性休克和/或荨麻疹病例中，有 276 例使用了苯海拉明，在应用抽样权重后，占病例总数的 62.0%。仅过敏性休克患者使用苯海拉明的比例为 58.0%，仅荨麻疹患者使用苯海拉明的比例为 69.5%，同时出现两种情况的患者使用苯海拉明的比例为 73.4%。从 2019 年到 2021 年，苯海拉明的使用没有发生明显变化（P=0.9421）。结论尽管有关苯海拉明使用的证据不断涌现，临床指南也在不断发展，但我们的研究结果表明，AAAAI 更新后，急诊室的做法没有发生明显变化。展望未来，缩小循证指南与临床实践之间的差距对于加强患者护理、确保遵守荨麻疹和过敏性休克管理方面不断发展的标准至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Allergy Asthma & Immunology 医学-过敏

CiteScore

6.50

自引率

6.80%

发文量

437

审稿时长

33 days

期刊介绍： Annals of Allergy, Asthma & Immunology is a scholarly medical journal published monthly by the American College of Allergy, Asthma & Immunology. The purpose of Annals is to serve as an objective evidence-based forum for the allergy/immunology specialist to keep up to date on current clinical science (both research and practice-based) in the fields of allergy, asthma, and immunology. The emphasis of the journal will be to provide clinical and research information that is readily applicable to both the clinician and the researcher. Each issue of the Annals shall also provide opportunities to participate in accredited continuing medical education activities to enhance overall clinical proficiency.