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Real life evaluation of the degree of compliance to recommendations of anaphylaxis guidelines in an emergency department of a tertiary hospital

Ponce Guevara LV1,2, Laffond Yges E1,2,3, Gracia Bara MT1,2, Moreno Rodilla E1,2,3, Muñoz Bellido FJ1,2,3, Lázaro Sastre M1,2, Macías Iglesias EM1,2, de Arriba Méndez S1,2, Campanón Toro MV1,2, Dávila Gónzalez I1,2,3

1Department of Allergy, University Hospital of Salamanca, Spain
2Biosanitary Institute of Salamanca, IBSAL, Salamanca, Spain
3Department of Biomedical and Diagnostic Sciences, University of Salamanca, Spain

J Investig Allergol Clin Immunol 2018; Vol. 28(4)
doi: 10.18176/jiaci.0243

Background: To date, few studies have evaluated the degree of compliance with recommendations of anaphylaxis guidelines in emergency departments (EDs).
Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines recommendations in an ED of a tertiary hospital.
Methods: Medical records of patients that were assisted in the ED of the University Hospital of Salamanca (Spain) were reviewed. Those patients fulfilling anaphylaxis criteria proposed by the NIAID/FAAN were selected.
Results: During one year period, we identified 89 patients, 74 adults and 15 children. In the 65% of adults the anaphylactic reaction was moderate, in 34% severe and in 1% very severe. In children, all reactions were moderate. Less than half (42%) of patients received adrenaline at ED, which was administered intramuscularly only in 19% of the cases. Regarding the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were no treated with adrenaline. At discharge from ED, an adrenaline auto-injector was recommended only to 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs. 27% children, p=0.047), 29% instructions about avoidance of triggers (31% adults vs. 20% children, n.s.), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs. 100% children, p<0.001).
Conclusion: The results of the study show a large discrepancy between guidelines recommendations and anaphylaxis management in ED. Additional efforts in education to improve the treatment of patients with anaphylactic reactions are needed. 

Key words: Anaphylaxis, Guidelines, Adrenaline