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Adherence to Anaphylaxis Guidelines: Real-World Data From the 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) : 246-252
doi: 10.18176/jiaci.0243

Background: Few studies have evaluated adherence to anaphylaxis guidelines in emergency departments (EDs).
Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines in the ED of a tertiary hospital.
Methods: Medical records of patients attended in the ED of University Hospital of Salamanca, Spain were reviewed. Those patients fulfilling the anaphylaxis criteria proposed by the NIAID/FAAN were selected.
Results: During a 1-year period, we identified 89 patients (74 adults and 15 children). The anaphylactic reaction was moderate in 65% of adults, severe in 34%, and very severe in 1%. In children, all reactions were moderate. Fewer than half of the patients (42%) received adrenaline in the ED; this was administered intramuscularly in only 19% of cases. As for the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were not treated with adrenaline. At discharge from the ED, an adrenaline auto-injector was recommended to only 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs 27% children, P=.047), 29% instructions about avoidance of triggers (31% adults vs 20% children, NS), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs 100% children, P<.001).
Conclusion: The results of the study show a large discrepancy between recommendations in guidelines and management of anaphylaxis in the ED. Additional training efforts are needed to improve the treatment of patients with anaphylactic reactions.

Key words: Anaphylaxis, Guidelines, Adrenaline