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Anaphylaxis management in a French pediatric emergency department: Lessons from the ANA-PED study
Evangéline Clark1,2, Luciana Kase Tanno1,2, Tram Vo3
1Allergy Unit of the Pneumology, Allergy and Thoracic Oncology Service, University Hospital of Montpellier, Montpellier, France.
Insights
Pediatric anaphylaxis management in emergency departments shows significant gaps, with low epinephrine use and auto-injector prescriptions. Improving guidelines and collaboration can enhance care for children with severe allergic reactions.
Area of Science:
- Pediatric Emergency Medicine
- Allergy and Immunology
- Clinical Research
Background:
- Anaphylaxis is a severe, life-threatening hypersensitivity reaction requiring immediate epinephrine administration.
- Current emergency department (ED) practices for pediatric anaphylaxis management require assessment.
Purpose of the Study:
- To evaluate the appropriateness of epinephrine use in children diagnosed with anaphylaxis in the ED.
- To identify factors influencing epinephrine administration, auto-injector prescription, and allergist referral.
Main Methods:
- Retrospective cross-sectional study conducted at a pediatric ED.
- Inclusion of consecutive children with allergy-related diagnoses between 2016 and 2020.
Main Results:
- 21.2% of allergy-related visits resulted in an anaphylaxis diagnosis.
- Only 17.0% of anaphylaxis cases received epinephrine; 28.1% were prescribed an auto-injector.
- Asthma symptoms and extensive skin reactions were associated with increased epinephrine administration.
Conclusions:
- Significant gaps exist in pediatric anaphylaxis management within EDs.
- Disseminating guidelines and fostering collaboration between specialists and emergency physicians can improve care pathways.
Background:
Anaphylaxis is a serious systemic hypersensitivity reaction that requires immediate recognition and prompt administration of epinephrine/adrenaline. The present study aimed to assess the appropriateness of epinephrine/adrenaline use in children identified as allergic by physicians in the emergency department (ED) at the time of the reaction, and to identify factors that are possibly associated with epinephrine/adrenaline administration, auto-injector prescription, and further referral to an allergist.
Methods:
We performed a retrospective cross-sectional study at the pediatric ED of the University Hospital of Montpellier, France. We included all consecutive children who attended the ED between 2016 and 2020 with an allergy-related diagnosis at discharge.
Results:
We included 1056 allergy-related visits, including 224 (21.2%) with a diagnosis of anaphylaxis at discharge; only 17.0% of them received an epinephrine/adrenaline injection, and 57.1% consulted an allergist after the acute episode. An auto-injector was prescribed to 63 (28.1%) patients at discharge from the ED. Besides the severity of the clinical presentation, factors associated with a guidelines-based management of the anaphylactic reaction and with an increased administration rate of epinephrine/adrenaline included presence of asthma symptoms and presence of extended skin reactions.
Conclusions:
Our study underlines persistent gaps in the management of pediatric anaphylaxis in ED, focusing on hereby identified levers. By disseminating current knowledge and guidelines on anaphylaxis and allergies, specialists could work together with emergency physicians to establish effective management algorithms and improve anaphylaxis management and care pathways for children experiencing allergic reactions, especially anaphylaxis.
Trail Registration:
Clinical Trials, number NCT05112367.
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