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

Publication date: Available online 17 January 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Kristina Rueter, Brennan Ta, Natasha Bear, Michaela Lucas, Meredith L. Borland, Susan L. Prescott
BackgroundWe recently determined that allergy training programs have improved physician recognition and diagnosis of pediatric anaphylaxis in the last decade.ObjectiveTo investigate for changes in management, in particular the appropriate use of adrenaline for the treatment of anaphylaxis in a tertiary pediatric emergency department (PED).MethodsWe 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.ResultsIn 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).ConclusionsThere 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.