Epinephrine is the only first-line treatment for anaphylaxis, a severe, life-threatening allergic reaction. However, a July 2017 study suggests that most children and young adults receiving emergency care for anaphylaxis are not given epinephrine at the onset of symptoms, when the life-saving medication is most effective. Published in the Annals of Allergy, Asthma and Immunology, the study found that 36 percent of young patients seeking emergency care for symptoms of anaphylaxis received epinephrine prior to arrival at the emergency department or urgent care center.
Researchers examined the medical records of 408 patients ages 25 or younger (mean age 7 years) who were treated at Nationwide Children’s Hospital in Columbus, OH between 2009 and 2013. The patients had diagnoses and evaluations consistent with anaphylaxis. About two-thirds of patients had a known history of anaphylaxis, and almost half had been prescribed an epinephrine auto-injector previously. Nearly all (98 percent) of the patients who had a prescription for epinephrine had experienced anaphylaxis in the past. However, 30 percent of the patients with epinephrine prescriptions did not have access to an auto-injector at the time of their reaction.
Among the 364 patients for whom medication use was documented, roughly 80 percent received at least one drug. The drug most commonly used prior to emergency room arrival was not epinephrine, but rather antihistamines like Benadryl, which were given to nearly half of the patients. Compared to patients who did not receive epinephrine prior to ER care, patients who were given epinephrine before reaching the ER were more likely to be discharged to home.
For 233 patients, medical records noted the patient’s location when the reaction took place. More than 60 percent of patients who had a reaction at school received epinephrine prior to ER arrival. The odds of being treated with an epinephrine auto-injector were significantly lower when a reaction occurred at home, where less than a third of patients received epinephrine. The reasons for this finding were not addressed in the study. However, one of the co-authors, Dr. David Stukus, noted to the online publication Fatherly that parents’ strong emotions might make administering an epinephrine auto-injector more difficult: “”I have heard a lot of concern from caregivers about being nervous to inject a needle into their child. I’ve had I my own patient’s parents tell me, ‘I knew what I should have done. I was trained on it, but I was too scared to do it.'”
Patients whose symptoms affected more than one organ system were less likely to receive epinephrine than patients with symptoms confined to a single organ system. This finding directly contradicts the guidance provided by emergency care plans and indicates that more educational outreach is needed FARE offers a suite of anaphylaxis resources to help patients and caregivers learn to identify anaphylaxis and treat this serious and potentially lethal condition effectively.