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Meta-Analysis
. 2023 Jul-Dec;19(9):1171-1181.
doi: 10.1080/1744666X.2023.2229517. Epub 2023 Jun 26.

Epinephrine treatment of food-induced and other cause anaphylaxis in United States and Canadian Emergency Departments: a systematic review and meta-analysis

Geneva D Mehta  1 , Joumane El Zein  2 , Isis Felippe Baroni  2 , Myrha Qadir  2 , Carol Mita  3 , Rebecca E Cash  2 , Carlos A Camargo Jr  2
Affiliations
Meta-Analysis

Epinephrine treatment of food-induced and other cause anaphylaxis in United States and Canadian Emergency Departments: a systematic review and meta-analysis

Geneva D Mehta et al. Expert Rev Clin Immunol. 2023 Jul-Dec.

Abstract

Introduction: Studies from more than 10 years ago showed epinephrine treatment of food-induced anaphylaxis in the emergency department (ED) was unacceptably low. We investigated whether epinephrine treatment of food-induced and other cause anaphylaxis in United States and Canadian EDs has changed over time.

Methods: Guided by a health sciences librarian, we performed a systematic search in Medline, Embase, and Web of Science on 11 January 2023. We included observational studies that reported epinephrine use to treat anaphylaxis in the ED. We stratified by anaphylaxis etiology (food-, venom-, medication-induced, or any cause). Associations between year and epinephrine use were tested using Spearman correlation and proportional meta-analysis.

Results: Of 2458 records identified in our initial search, 40 met inclusion criteria. Of these, 14 examined food-induced, 4 venom-induced, 0 medication-induced, and 24 any cause anaphylaxis. For epinephrine treatment of food-induced anaphylaxis in the ED, among studies using similar definition of anaphylaxis, meta-analysis showed a pooled value of 20.7% (95% CI 17.8, 23.8) for studies performed >10 years ago and 45.1% (95% CI 38.4, 52.0) from those in the last 10 years. For anaphylaxis of any cause, there was no change over time, with a pooled value of 45.0% (95% CI 39.8, 50.3) over the last 10 years.

Discussion: Epinephrine treatment of food-induced anaphylaxis in the ED has increased over time. There was no clear change for anaphylaxis of any cause. Over the last 10 years, approximately 45% of ED patients with anaphylaxis received epinephrine. A limitation of the evidence is heterogeneity in anaphylaxis definitions.

Keywords: Anaphylaxis; epinephrine; food-induced anaphylaxis; meta-analysis; proportion; systematic review; treatment.

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Conflict of interest statement

Declaration of interest

Over the past 30 years, C Camargo has done paid consultation for several companies that make epinephrine auto-injectors (Mylan, Kaleo) or that are developing new modes of epinephrine delivery (Hikma, Bryn). He also has served on scientific advisory boards for these same companies. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.
PRISMA flowchart: selection process of the included articles
Figure 2.
Figure 2.
Epinephrine use in the emergency department, pre-ED or either location for treatment of food-induced anaphylaxis. ED: Emergency Department
Figure 3.
Figure 3.
Forest plot – Epinephrine use in the emergency department to treat food-induced anaphylaxis by time period, among studies using similar definition of anaphylaxis. All studies included in meta-analysis use National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) definition of anaphylaxis
Figure 4.
Figure 4.
Frequency of epinephrine prescription and allergy referral on emergency department discharge among patients presenting with food-induced anaphylaxis. ED: Emergency Department
Figure 5.
Figure 5.
Epinephrine use in the emergency department, pre-ED or either location for treatment of anaphylaxis of any cause. ED: Emergency Department.
See this image and copyright information in PMC

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References

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