Implementation of anaphylaxis management guidelines: a register-based study

Abstract

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.

Figure 1. Drugs used for emergency treatment of anaphylaxis, by cause.

Only assured cases. All application routes, error bars indicate 95% confidence intervals.

Figure 2. Drugs used for emergency treatment of anaphylaxis, by age.

Dashed lines indicate proportion of patients having received inhalation (adrenaline) or oral (antihistamine, corticoid) treatment only, error bars indicate 95% confidence intervals.

Figure 3. Drugs used by emergency physicians for initial treatment of anaphylaxis.

Firsthand report (EPs) vs. self report (anaphylaxis registry). Parenteral application routes only. * Weighted for age, cause and severity distribution in anaphylaxis registry, Berlin catchment area.

Figure 4. First time receiving prophylactic first aid drugs following severe anaphylaxis.