Increased Use of Adrenaline in the Management of Childhood Anaphylaxis Over the Last Decade

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Abstract

Background: We recently determined that allergy training programs have improved physician recognition and diagnosis of pediatric anaphylaxis in the last decade. Objective: To investigate for changes in management, in particular the appropriate use of adrenaline for the treatment of anaphylaxis in a tertiary pediatric emergency department (PED). Methods: We conducted a retrospective case note study including children aged 0 to 16 years coded and verified for anaphylaxis comparing cases in years 2003/2004 with 2012. This included standardized information on clinical presentation, demographic characteristics, vital signs, mode of transport, and management of anaphylaxis including the use of adrenaline and/or adjunct therapy. Follow-up management plans were also recorded. Results: In 2003/2004, a total of 92 cases were coded and verified for anaphylaxis from 83,832 PED presentations compared with 159 cases from 71,822 PED presentations in 2012. A significantly higher proportion of cases were appropriately managed with adrenaline in 2012 compared with 2003/2004, when intensive training programs had not yet been introduced (P =.03). Vital signs were more frequently documented in 2012 (P <.001) than in 2003/2004, and there was significantly less administration of other medications (corticosteroids, bronchodilators, and antihistamines) (P <.05). Also, changes in discharge management occurred with an improved dispensing/prescription of adrenaline autoinjectors and more frequent follow-up arrangement with specialist allergy services (P <.001). Conclusions: There was a significant improvement in the management of anaphylaxis over this 10-year period. This change was observed after the introduction of intensified physician training programs in which anaphylaxis management was a key component highlighting the importance of cooperation between pediatric emergency and allergy services.

Original languageEnglish
Pages (from-to)1545-1552
Number of pages8
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume6
Issue number5
DOIs
Publication statusPublished - 1 Sep 2018

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