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Management of pediatric allergic reaction: Practice patterns of Canadian pediatric emergency physicians

Caitlin Prendergast1,2, Amy C Plint1,2,3, Ken Tang4

  • 1Division of Emergency Medicine, CHEO, Ottawa, ON.

CJEM
|January 15, 2021
PubMed

Insights

Pediatric emergency physicians accurately recognized anaphylaxis but showed gaps in management, particularly in recognizing cases without typical symptoms and consistently prescribing epinephrine. These findings highlight areas for improvement in pediatric anaphylaxis care.

Area of Science:

  • Pediatric Emergency Medicine
  • Allergy and Immunology
  • Clinical Practice Guidelines

Background:

  • Anaphylaxis is a severe, potentially fatal allergic reaction with increasing incidence.
  • Existing literature suggests deficiencies in anaphylaxis recognition and management.
  • Gaps in pediatric anaphylaxis care require examination.

Purpose of the Study:

  • To assess the extent of anaphylaxis diagnosis and management gaps in Canadian pediatric emergency medicine.
  • To identify specific areas of deficiency in recognizing and treating anaphylaxis among pediatric emergency physicians.

Main Methods:

  • A self-administered survey was distributed to physicians in the Pediatric Emergency Research Canada (PERC) network.
  • The survey included four clinical scenarios to evaluate diagnosis and management of anaphylaxis based on National Institute of Allergy and Infectious Diseases (NIAID) criteria.
  • Questions covered diagnosis, treatment with epinephrine, observation times, and physician demographics.

Main Results:

  • A 71% response rate (152/214) was achieved.
  • Anaphylaxis recognition rates were high (93-99%) for NIAID criteria.
  • Epinephrine prescription varied (72-96%), with 54% of respondents consistently treating indicated cases.

Conclusions:

  • While most pediatric emergency physicians recognize anaphylaxis, significant management gaps persist.
  • Key deficiencies include recognizing anaphylaxis without urticaria or pulmonary symptoms and consistent epinephrine use.
  • Addressing these management gaps is crucial for improving care for pediatric patients experiencing anaphylaxis.
Abstract

Keywords:
Anaphylaxisemergency medicineepinephrinepediatrics

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