Emergency Treatment Of Anaphylaxis Research Articles

Global disparities in availability of epinephrine auto-injectors

BackgroundAnaphylaxis is the most severe clinical presentation of acute systemic allergic reactions and can cause death. Given the prevalence of anaphylaxis within healthcare systems, it is a high priority public health issue. However, management of anaphylaxis – both acute and preventative – varies by region. MethodsThe World Allergy Organization (WAO) Anaphylaxis Committee and the WAO Junior Members Steering Group undertook a global online survey to evaluate local practice in the diagnosis and management of anaphylaxis across regions. ResultsResponses were received from WAO members in 66 countries. While intramuscular epinephrine (adrenaline) is first-line treatment for anaphylaxis, some countries continue to recommend alternative routes in contrast to guidelines. Epinephrine auto-injector (EAI) devices, prescribed to individuals at ongoing risk of anaphylaxis in the community setting, are only available in 60% of countries surveyed, mainly in high-income countries. Many countries in South America, Africa/Middle-East and Asian-Pacific regions do not have EAI available, or depend on individual importation. In countries where EAIs are commercially available, national policies regarding the availability of EAIs in public settings are limited to few countries (16%). There is no consensus regarding the time patients should be observed following emergency treatment of anaphylaxis. ConclusionThis survey provides a global snapshot view of the current management of anaphylaxis, and highlights key unmet needs including the global availability of epinephrine for self-injection as a key component of anaphylaxis management.

A quality improvement project (QIP) on the awareness of the revised anaphylaxis guidelines identified through simulation

Anaphylaxis is an important emergency which forms part of the adult Advanced Life Support guidelines. The guidelines for anaphylaxis have recently undergone a change in the 2021 revision, with steroids and antihistamine no longer advised for acute anaphylaxis and an adrenaline infusion included as part of the new refractory anaphylaxis algorithm [1]. Scenarios for the medical trainees run at our simulation centre identified a lack of awareness of the revised anaphylaxis guidelines among learners. A QIP was completed to improve the level of learners’ awareness and confidence of the revised anaphylaxis guidelines in conjunction with the simulation team. Online surveys were sent out to the medical registrars and internal medicine trainees regarding the revised anaphylaxis guidelines. This was followed by an email sent two weeks later with the revised guidelines highlighting key changes. The same group were subsequently re-surveyed two weeks following the intervention to identify changes in clinical practice. Concurrently, scenarios based on the revised anaphylaxis guidelines were run for the medical trainees with specific emphasis on whether trainees were aware of the need for an adrenaline infusion (managed in a specialist setting) if symptoms were ongoing despite two IM doses of adrenaline. In the post-simulation debriefing, discussion was focused on the change in the anaphylaxis guidelines. In the first cycle, 100% of 23 respondents felt confident managing anaphylaxis but only 50% of respondents were aware (and were confident) that the guidelines had been revised. 2/3 of respondents had not managed a case of anaphylaxis in the last 12 months. In the second cycle, 100% of 4 respondents were aware of the revised guidelines but only 75% of respondents were confident in following the guidelines. 75% of respondents had not managed a case of anaphylaxis in the last 12 months. The significant drop in number of responders is likely to be multifactorial but may reflect a change in focus of educational needs due to the ongoing COVID-19 pandemic leading to a change in the educational landscape. A survey done on the attitude of medical students during the COVID-19 pandemic towards online learning found that only 54.1% of respondents felt that interactive discussion could occur through e-learning [2]. Following the QI results, the cardiac arrest trolleys were checked and the emergency box with adrenaline now includes the revised anaphylaxis algorithm but not hydrocortisone and chlorphenamine. Refractory anaphylaxis is now a standard scenario for the medical trainees in our simulation centre. 1. Resuscitation Council UK. Emergency treatment of anaphylaxis: Guidelines for healthcare providers. 2021. 2. Alsoufi A, Alsuyihili A, Msherghi A, Elhadi A, Atiyah H, Ashini A, Ashwieb A, Ghula M, Ben Hasan H, Abudabuos S, Alameen H, Abokhdhir T, Anaiba M, Nagib T, Shuwayyah A, Benothman R, Arrefae G, Alkhwayildi A, Alhadi A, Zaid A, Elhadi M. Impact of the COVID-19 pandemic on medical education: Medical students’ knowledge, attitudes, and practices regarding electronic learning. PLoS One. 2020;15(11):e0242905.

Emergency treatment of anaphylaxis: concise clinical guidance

Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. It is characterised by the rapid development of airway and/or breathing and/or circulation problems. Intramuscular adrenaline is the most important treatment, although, even in healthcare settings, many patients do not receive this intervention contrary to guidelines. The Resuscitation Council UK published an updated guideline in 2021 with some significant changes in recognition, management, observation and follow-up of patients with anaphylaxis. This is a concise version of the updated guideline.

Improving medical workforce knowledge of adrenaline (epinephrine) administration in treatment of anaphylaxis in adults

Aim: To compare results of repeated surveys (2010, 2015 and 2017) regarding the knowledge of the medical workforce potentially involved in adrenaline administration for the emergency treatment of anaphylaxis in adults Methods: Convenience samples of medical (and advanced nursing) staff were surveyed on three separate occasions (2010, 2015 and 2017). Several educational methods were used to increase awareness of the specific administration of adrenaline. Results: Overall, knowledge of the medical workforce regarding correct first dose adrenaline administration improved from 15% in 2010 to 49% in 2015 and finally 63% in 2017. Conclusion: This survey comparison shows knowledge of the medical workforce regarding adrenaline administration for treatment of anaphylaxis in adults can be significantly improved by employing a variety of educational methods.

Emergency treatment of anaphylaxis in Japanese beekeepers

Emergency treatment of anaphylaxis in Japanese beekeepers

The administration of blood components: a British Society for Haematology Guideline.

The administration of blood components: a British Society for Haematology Guideline.

Corticosteroids in management of anaphylaxis; a systematic review of evidence.

As anaphylaxis is a medical emergency, there are no randomized controlled clinical trials on its emergency management. Therefore, current guidelines are mostly based on data from observational studies, animal and laboratory studies. Although epinephrine is the mainstay of recommended treatment, corticosteroids are also frequently used. This review evaluates the evidence on the use of corticosteroids in emergency management of anaphylaxis from published human and animal or laboratories studies. Thirty original research papers were found with 22 human studies and eight animal or laboratory studies. The average rate of corticosteroid use in emergency treatment was 67.99% (range 48% to 100%). Corticosteroids appear to reduce the length of hospital stay, but did not reduce revisits to the emergency department. There was no consensus on whether corticosteroids reduce biphasic anaphylactic reactions. None of the human studies had sufficient data to compare the response to treatment in different treatment groups (i.e. corticosteroids, epinephrine, antihistamines). Animal studies demonstrated that corticosteroids act through multiple mechanisms. These modulate gene expression, with effects becoming evident 4 to 24 hours after administration. A much quicker response has been detected within 5 to 30 minutes, through blockade of signal activation of glucocorticoid receptors independent of their genomic effects. Therefore, we conclude that there is no compelling evidence to support or oppose the use of corticosteroid in emergency treatment of anaphylaxis. However, based on the available data, it appears to be beneficial and there was no evidence of adverse outcomes related to the use of corticosteroids in emergency treatment of anaphylaxis.

Do Corticosteroids Prevent Biphasic Anaphylaxis?

Anaphylaxis is a severe hypersensitivity reaction that is rapid in onset and can result in death. The pattern of an anaphylactic reaction can be uniphasic (or monophasic), biphasic (also called delayed or late phase), or refractory in nature. The most widely cited definition of biphasic anaphylaxis is a recurrence of anaphylactic symptoms after initial resolution despite no further exposure to the trigger. Corticosteroids are thought by some to prevent the development of biphasic symptoms and, therefore, commonly used in the emergency treatment of anaphylaxis but this has not been systemtically analyzed. In this review, Ovid MEDLINE, Ovid EMBASE, Web of Science, and Scopus were searched for articles using "anaphylaxis" combined with the key terms "biphasic" and/or "corticosteroids" and/or "epinephrine." A total of 31 appropriate studies were identified. Biphasic anaphylactic reactions are more likely to occur in moderate to severe anaphylaxis or when anaphylaxis is not treated with timely epinephrine. Because of the potential detrimental adverse effects of corticosteroids and lack of compelling evidence demonstrating an effective role in reducing anaphylaxis severity or preventing biphasic anaphylaxis, we do not advocate for their routine use in anaphylaxis.

Staphylococcus aureus effusive constrictive pericarditis complicated by right coronary artery mycotic aneurysm and right ventricular infarction

Anaphylaxis is a severe hypersensitivity reaction that is rapid in onset and can result in death. The pattern of an anaphylactic reaction can be uniphasic (or monophasic), biphasic (also called delayed or late phase), or refractory in nature. The most widely cited definition of biphasic anaphylaxis is a recurrence of anaphylactic symptoms after initial resolution despite no further exposure to the trigger. Corticosteroids are thought by some to prevent the development of biphasic symptoms and, therefore, commonly used in the emergency treatment of anaphylaxis but this has not been systemtically analyzed. In this review, Ovid MEDLINE, Ovid EMBASE, Web of Science, and Scopus were searched for articles using “anaphylaxis” combined with the key terms “biphasic” and/or “corticosteroids” and/or “epinephrine.” A total of 31 appropriate studies were identified. Biphasic anaphylactic reactions are more likely to occur in moderate to severe anaphylaxis or when anaphylaxis is not treated with timely epinephrine. Because of the potential detrimental adverse effects of corticosteroids and lack of compelling evidence demonstrating an effective role in reducing anaphylaxis severity or preventing biphasic anaphylaxis, we do not advocate for their routine use in anaphylaxis.

Epinephrine Auto-Injectors

Anaphylaxis is a systemic, life-threatening reaction and immediate treatment is essential. The reaction can be fatal even with epinephrine injection. Epinephrine auto-injectors have been used in the emergency treatment of anaphylaxis since the 1980s. In this review, indications for the prescription, types, administration, and the problems with the use of epinephrine auto-injectors are discussed. The importance of patient and caregiver education is highlighted.

Do epinephrine auto-injectors have an unsuitable needle length for young children?

Background Epinephrine delivered by an auto-injector to the anterolateral aspect of the thigh is the standard of care for the emergency treatment of anaphylaxis. For most pediatric patients in Canada, the EpipenJr is prescribed, which has a needle length of 12.7mm. The route of epinephrine administration affects its onset of action, and intramuscular delivery is recommended for rapid absorption. If epinephrine is injected subcutaneously, the absorption will be slower. Conversely, if it is injected into the bone, the absorption will be unpredictable. There are no published clinical studies assessing whether the needle length of the EpipenJr is adequate to deliver epinephrine intramuscularly in pediatric patients at risk of anaphylaxis.

Emergency treatment of anaphylaxis in infants and children

Anaphylaxis is a severe, acute and potentially life-threatening condition, often in response to an allergen. Patients experiencing anaphylaxis can present with cutaneous, respiratory, cardiovascular or gastrointestinal manifestations. Epinephrine given intramuscularly remains the mainstay of treatment for this condition. Other second-line therapies, such as inhaled beta-2 agonists, H1 and H2 receptor antagonists and corticosteroids, may play a role in resolving respiratory and cutaneous signs and symptoms. Biphasic reactions may occur during the resolution phase of symptoms and, thus, all patients should be observed for a minimum of 4 h to 6 h before discharge from hospital. On discharge, all patients should be prescribed epinephrine autoinjectors, and referred to an allergist or immunologist for further evaluation and education.

What are the ‘ideal’ features of an adrenaline (epinephrine) auto-injector in the treatment of anaphylaxis?

Anaphylaxis is a systemic allergic reaction that often involves respiratory symptoms and cardiovascular collapse, which are potentially life-threatening if not treated promptly with intramuscular adrenaline. Owing to the unpredictable nature of anaphylaxis and accidental exposure to allergens (such as peanuts and shellfish), patients should be prescribed intramuscular adrenaline auto-injectors and carry these with them at all times. Patients also need to be able to use their auto-injectors correctly while under high stress, when an anaphylactic attack occurs. Despite this, an alarming number of patients fail to carry their auto-injectors and many patients, carers of children with known anaphylaxis and healthcare professionals do not know how to use the device correctly, despite having had training. Currently available auto-injector devices have various limitations that may impede their use in the management of anaphylaxis. There is also a lack of validated assessment criteria and regulatory requirements for new devices. This review describes the different delivery systems used in currently available auto-injectors and discusses the key barriers to the use of adrenaline auto-injectors, with the goal of identifying the 'ideal' features/characteristics of such devices in the emergency treatment of anaphylaxis that will ensure ease of use, portability and accurate delivery of a life-saving drug.

Anaphylaxie – Realität der Akuttherapie und präventiver Maßnahmen. Analyse von 54 Patienten eines spezialisierten Stadtspitals

Background: Anaphylaxis is an acute generalized hypersensitivity reaction initiated by various triggers which involves the entire organism and which may be life threatening. Although international guidelines for the emergency treatment of anaphylaxis have been published, the therapeutic recommendations are implemented differently. In this study besides the etiology of anaphylaxis, we were interested in how and where the patients have been treated and whether or not this reaction did occur for the first time. Methods: From January 1 to December 31 of 2008 1,075 patients have been referred to the allergy unit of the communal hospital in Berne (Zieglerspital) for an allergological work-up. 54 (5.0%) of them had had an anaphylaxis defined as shock, drop of blood pressure or collapse. The examination consisted of a detailed history and a comprehensive allergological assessment. Results: The average age of the 54 patients ― 28 women (52%) - was 43 years. In 46 (85%) of them the cause for anaphylaxis was a Hymenoptera venom allergy. Other triggers were: drugs [3], exercise-induced [2], multi-factorial [2] and food [1]. 20/54 subjects (37%) had a recurrent systemic reaction; all of them were allergic to Hymenoptera venom. 6 of them (30%) possessed emergency medications (antihistamines/corticosteroids); none of them had an epinephrine-autoinjector. 48/54 patients (89%) have been treated in a hospital or by the emergency doctor; 2/6 were supported by family members, and 4 recovered spontaneously. For therapy most often corticosteroids (92%) and antihistamines (89%) were used; epinephrine, however, only in 9 cases (17%). Conclusion: This investigation shows that emergency treatment of anaphylaxis in the region of Bern does not concur with the advocated guidelines. Epinephrine as first-line therapy in anaphylaxis has been used rarely. More than one-third of the patients already had a previous allergic generalized reaction elicited by the same culprit (in our case hymenoptera stings). Only one-third of these carried emergency medications but none of them possessed an epinephrine-autoinjector.

Emergency treatment of anaphylaxis in adults: concise guidance

Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction characterised by rapidly developing life-threatening airway, breathing and/or circulation problems usually associated with skin and mucosal changes. Updated guidance on the recognition, acute management and follow up of adults with anaphylaxis has recently been published. This is a concise version of the full guidelines published by the Resuscitation Council (UK) in 2008. The use of an airway, breathing, circulation, disability and exposure approach to recognise and treat anaphylaxis is emphasised.

Emergency treatment of anaphylaxis: implications for nurses

Emergency treatment of anaphylaxis: implications for nurses

Serious Shortcomings in the Management of Children with Anaphylaxis in Scottish Schools

BackgroundThe United Kingdom incidence of anaphylaxis has increased very sharply over the last decade, with the highest rates of hospital admissions occurring in school-aged children. This raises concerns about the extent to which schools are aware of approaches to the prevention and treatment of anaphylaxis. Methods and Findings We undertook a national postal survey of 250 Scottish schools enquiring about approaches to managing children considered to be at risk of anaphylaxis. We obtained responses from 148 (60%) schools, 90 (61%) of which reported having at least one at risk child. Most (80%) schools with children considered to be at risk reported having personalised care plans and invariably reported having at least one member of staff trained in the emergency treatment of anaphylaxis. Access to adrenaline was available on-site in 97% of these schools. However, significantly fewer schools without children considered to be at risk reported having a trained member of staff (48%, p < 0.001), with access to adrenaline being very poor (12%, p < 0.001). Overall, 59% of respondents did not feel confident in their school's ability to respond in an emergency situation. Conclusions Most schools with children considered to be at risk of anaphylaxis report using personal care plans and having a member of staff trained in the use of, and with access to, adrenaline. The picture is, however, less encouraging in schools without known at risk children, both in relation to staff training and access to adrenaline. The majority of schools with at risk children have poorly developed strategies for preventing food-triggered anaphylaxis reactions. There is a need for detailed national guidelines for all schools, which the Scottish Executive must now ensure are developed and implemented.

Sublingual epinephrine tablets versus intramuscular injection of epinephrine: Dose equivalence for potential treatment of anaphylaxis

Epinephrine autoinjectors are underused in the emergency treatment of anaphylaxis in the community, perhaps in part because of fear of needles. To determine the sublingual epinephrine dose from a novel fast-disintegrating tablet required to achieve epinephrine plasma concentrations (EPPCs) similar to those obtained after epinephrine 0.3 mg intramuscular injection. In a prospective 5-way crossover study, sublingual tablets containing epinephrine 0, 10, 20, and 40 mg, and epinephrine 0.3 mg intramuscular in the thigh (EpiPen) were compared in a validated rabbit model. Blood samples were collected before dosing and 5, 10, 15, 20, 30, 40, 60, 90, 120, 150, and 180 minutes afterward. EPPCs were measured by using high-performance liquid chromatography-electrochemical detection. Pharmacokinetic parameters were calculated by using WinNonlin. The area under the curve (AUC), maximum concentration (C(max)), and time at which C(max) was achieved (T(max)) did not differ significantly (P > .05) after epinephrine 40 mg (AUC = 1861 +/- 537 ng/mL/min, C(max) = 31.0 +/- 13.1 ng/mL, and T(max) = 9 +/- 2 minutes) and epinephrine 0.3 mg intramuscular (AUC = 2431 +/- 386 ng/mL/min, C(max) = 50.3 +/- 17.1 ng/mL, and T(max) = 21 +/- 5 minutes). The AUC after tablets containing epinephrine 0 mg (AUC = 472 +/- 126 ng/mL/min), epinephrine 10 mg (AUC = 335 +/- 152 ng/mL/min), and epinephrine 20 mg (AUC = 801 +/- 160 ng/mL/min) did not differ significantly from each other, but were significantly lower (P < .05) than the AUC after epinephrine 0.3 mg intramuscularly. Sublingual administration of epinephrine 40 mg from this tablet formulation resulted in EPPCs similar to those obtained after epinephrine 0.3 mg intramuscular injection in the thigh. For treatment of anaphylaxis in the community, self-injectable epinephrine is underused. This novel, fast-disintegrating epinephrine tablet formulation for sublingual administration is a feasible alternative that warrants further development.

Emergency treatment of anaphylaxis

Anaphylaxis is a severe allergic reaction that is potentially fatal. It is the clinical manifestation of a syndrome that represents the most severe allergic reaction affecting the systemic circulation and respiratory function. The clinical presentation of anaphylaxis is a frequent event to all emergency departments (ED) and requires prompt recognition and immediate management. No reliable epidemiological data is available on the incidence of anaphylaxis partly because of the difficulty defining anaphylactic reactions (Resuscitation Council UK, 2005), however, one study found an incidence of 1:2300 attendees at an ED (Stewart and Ewan, 1996). The recent severe rise in childhood allergies and atopic conditions will result in an increasing prevalence of this condition. In addition most anaphylactic reactions are iatrogenic (Pumphrey, 2000), therefore, there is a clear need for practitioners to be able to assess, make a working diagnosis, plan, implement a plan of care with specific outcome identification, and evaluate the care of patients presenting with this condition.

Emergency Treatment of Anaphylaxis Lacking

Emergency Treatment of Anaphylaxis Lacking