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观点的转变:在美国紧急部门的过敏反应和疹中使用diphenhydramine
Jazeb Ifikhar1, Darby Sparks1, Amy D Hendrix-Dicken1
1University of Oklahoma School of Community Medicine, Department of Pediatrics, 4502 E 41st St, Tulsa, OK 74135, USA.
The American journal of emergency medicine
|May 9, 2025
概括
美国急诊部对疹和过敏反应的二胺使用在2019-2021年保持不变,尽管更新的指南建议不使用它. 这突显了医疗证据和临床实践之间对于这些过敏反应的差距.
科学领域:
- 紧急医疗 紧急医疗
- 过敏和免疫学 过敏和免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 由于副作用和优越的替代品,医疗共识已经改变了针对疹和过敏反应的迪芬胺.
- 目前的指导方针,如2020年AAAAI过敏反应建议,建议不要使用第一代抗胰岛素药物,如迪芬胺,用于急性过敏反应或预防双相反应.
研究的目的:
- 评估2019年至2021年期间美国急诊部 (ED) 用于治疗过敏反应和疹的二胺的利用情况.
- 为了确定2020年AAAAI指南是否影响了芬胺在ED治疗这些疾病的使用.
主要方法:
- 对2019-2021年国家医院门诊医疗调查 (NHAMCS) 数据的横截面分析.
- 专注于治疗过敏症或疹的ICD-10代码的患者的ED访问,他们接受了药物治疗.
- 分析了使用药物记录和采用基于设计的Pearson奇方位测试的diphenhydramine管理.
主要成果:
- 在450个涉及过敏反应和/或疹的病例中,在61.99%的病例中使用了二胺.
- 过敏反应的使用率为57.99%,疹的使用率为69.45%,两者的使用率为73.4%.
- 从2019年到2021年,没有观察到二胺使用的统计学意义上的变化 (P = .9421).
结论:
- 尽管更新了临床指导方针,但在过敏反应和尿疹治疗中使用迪芬胺的急诊室实践没有改变.
- 迫切需要弥合基于证据的建议与管理过敏反应的实际临床实践之间的差距.
- 需要进一步的研究,以确定阻碍美国EDs采用更新指南的障碍.
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