"Outdated protocols" and a lack of patient education around anaphylaxis treatment can result in poor patient outcomes, Medscape Medical News reported Oct. 28.
Here are seven things to know:
Education
A survey of 96 patients and caregivers was conducted in an allergy clinic waiting room. Of these, 95% were prescribed epinephrine.
1. The majority of respondents, 73%, said they were comfortable identifying signs of anaphylaxis, but only 14% said they used epinephrine as a first-line treatment.
2. Many patients and caregivers said they do not know which anaphylaxis symptoms to treat with epinephrine. About 23% of respondents said they use antihistamines as the first treatment in cases of anaphylaxis.
3. Common reasons respondents gave for avoiding epinephrine included uncertainty over which symptoms to treat, at 40.6%, hesitancy to visit an ED (24%), hesitancy to call 911 (17.7%), uncertainty on how to use epinephrine auto-injectors (11.5%) and a fear of needles (5.2%).
4. The fear of needles is considered a significant deterrent in epinephrine use. "However, our respondents were more inclined to acknowledge a reluctance to escalate to emergency response as the major barrier to treatment," Joni Chow, DO, a physician at Baylor College of Medicine in San Antonio, told Medscape.
Outdated Protocols
A separate study analyzed data from 30 states with mandatory advanced cardiac life support protocols to find gaps in recognizing the treating anaphylaxis.
1. Only 15 states included gastrointestinal symptoms in their definition of anaphylaxis, and only 40% included neurologic manifestations while 47% used two-organ system definitions.
2. All 30 state protocols recommended diphenhydramine and epinephrine for anaphylactic reactions. All but one state listed epinephrine as the first-line recommendation for anaphylaxis.
3. However, researchers found that many patients do not receive epinephrine from EMS personnel when they call 911.
"They receive antihistamines, steroids, everything except epinephrine, which is incredibly concerning given that epinephrine is always the first-line treatment for anaphylaxis," Carly Gunderson, DO, a physician at Memorial Healthcare System in Pembroke Pines, Fla., told Medscape. "Because EMS providers are often the first healthcare professionals to assess patients experiencing anaphylaxis, their ability to recognize and appropriately treat anaphylaxis is essential. We were also disappointed by how many protocols continue to recommend outdated interventions such as first-generation antihistamines and corticosteroids in the treatment of anaphylaxis."