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PLoS By Category | Recent PLoS Articles
Critical Care and Emergency Medicine - Dermatology - Immunology - Non-Clinical Medicine - Public Health and Epidemiology

Implementation of Anaphylaxis Management Guidelines: A Register-Based Study
Published: Thursday, May 10, 2012
Author: Linus Grabenhenrich et al.

by Linus Grabenhenrich, Stephanie Hompes, Hannah Gough, Franziska Ruëff, Kathrin Scherer, Claudia Pföhler, Regina Treudler, Vera Mahler, Thomas Hawranek, Katja Nemat, Alice Koehli, Thomas Keil, Margitta Worm

Background

Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines.

Methods

Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data.

Results

2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time.

Conclusion

There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted.

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