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

Paul V. Williams

doi:10.1542/peds.2019-2461S

K Rueter, B Ta, N Bear, M Lucas, ML Borland, SL Prescott. J Allergy Clin Immunol Pract. 2018;6(5):1545–1552

Purpose of the Study:

To determine if the management of anaphylaxis in children had improved over a 10-year period after the introduction of intensified training programs and new anaphylaxis guidelines, relating in particular to the use of adrenaline (epinephrine).

Study Population:

The population included 136 children <17 years of age who presented to the main tertiary pediatric emergency department in Perth, Australia, with anaphylaxis from January 1, 2003, to December 31, 2004, and 177 children from January 1, 2012, to December 31, 2012, after intensified training programs and new anaphylaxis guidelines were developed.

Methods:

The investigators used a retrospective chart review, using the criteria from the 2006 Second National Institute of Allergy and Infectious Diseases Food Allergy and Anaphylaxis Network symposium. All cases coded as anaphylaxis were independently reviewed to verify the diagnosis. The intensified training program was mandatory for all trainees rotating through the pediatric emergency department and was taught by a pediatric allergist and pediatric emergency physician.

Results:

There were significant increases in the appropriate treatment of anaphylaxis with adrenaline before and after arrival in the pediatric emergency department, reduced use of adjunctive medications, a greater proportion of children discharged with an adrenaline autoinjector, and a greater proportion of children referred to allergy services between the 2 time periods.

Conclusions:

An intensified training program for medical staff and improved cooperation between pediatric emergency specialists and allergists has improved the management of pediatric anaphylaxis over this 10-year period.

Reviewer Comments:

Use of epinephrine and compliance with anaphylaxis guidelines have been dismal in the United States and Europe, with significant underuse of epinephrine, low rates of discharge prescriptions for epinephrine autoinjectors, and low rates of referral to allergists. In this article, investigators demonstrated that an intense training program for both allergists and pediatric emergency department physicians can improve the compliance with anaphylaxis guidelines and should be of particular interest to training program directors of pediatric programs. Even with this intensified training program, however, mismanagement still occurred in 24.5% of patients.