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J Allergy Clin Immunol Pract. 2019 Sep - Oct;7(7):2232-2238.e3. doi: 10.1016/j.jaip.2019.04.018. Epub 2019 Apr 26.

Evaluation of Prehospital Management in a Canadian Emergency Department Anaphylaxis Cohort.

Author information

1
Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: sofiannegabrielli@gmail.com.
2
Division of Rheumatology, Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada.
3
Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada.
4
Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
5
Division of Emergency Medicine, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec, Canada.
6
Division of Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
7
Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
8
Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, Canada.
9
Division of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, Canada.
10
Division of Pediatrics and Emergency Medicine, Children's Hospital at London Health Science Centre, London, Ontario, Canada.
11
Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.
12
Food Allergy Canada, Toronto, Ontario, Canada.
13
Food Directorate, Health Canada, Ottawa, Ontario, Canada; Département sciences des aliments, Faculté des sciences de l'agriculture et de l'alimentation, Université Laval, Québec City, Québec, Canada.
14
Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
15
Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.

Abstract

BACKGROUND:

Studies assessing the use of antihistamines and corticosteroids for the treatment of anaphylaxis have not supported a conclusive effect.

OBJECTIVE:

To assess prehospital management of anaphylaxis by measuring the effect of epinephrine use compared with antihistamines and corticosteroids on negative outcomes of anaphylaxis (intensive care unit/hospital ward admission, multiple doses of epinephrine in the emergency department [ED], and intravenous fluids given in the ED).

METHODS:

The Cross-Canada Anaphylaxis Registry is a cohort study that enrolls anaphylaxis cases presenting to EDs in 5 Canadian provinces over a 6-year period. Participants were recruited prospectively and retrospectively and were excluded if the case did not meet the definition of anaphylaxis.

RESULTS:

A total of 3498 cases of anaphylaxis, of which 80.3% were children, presented to 9 EDs across Canada. Prehospital treatment with epinephrine was administered in 31% of cases, whereas antihistamines and corticosteroids were used in 46% and 2% of cases, respectively. Admission to the intensive care unit/hospital ward was associated with prehospital treatment with corticosteroids (adjusted odds ratio, 2.84; 95% confidence interval [CI], 1.55, 6.97) while adjusting for severity, treatment with epinephrine and antihistamines, asthma, sex, and age. Prehospital treatment with epinephrine (adjusted odds ratio, 0.23; 95% CI, 0.14, 0.38) and antihistamines (adjusted odds ratio, 0.61; 95% CI, 0.44, 0.85) decreased the likelihood of receiving multiple doses of epinephrine in the ED, while adjusting for severity, treatment with corticosteroids, asthma, sex, and age.

CONCLUSIONS:

Prompt epinephrine treatment is crucial. Use of antihistamines in conjunction with epinephrine may reduce the risk of uncontrolled reactions (administration of 2 or more doses of epinephrine in the ED), although our findings do not support the use of corticosteroids.

KEYWORDS:

Anaphylaxis; Antihistamine; Corticosteroids; Epinephrine; Prehospital management

PMID:
31035000
DOI:
10.1016/j.jaip.2019.04.018

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