Anaphylaxis management in a French pediatric emergency department: Lessons from the ANA-PED study

Abstract

Background: Anaphylaxis is a serious systemic hypersensitivity reaction that requires immediate recognition and prompt administration of epinephrine/adrenaline. The present study aimed to assess the appropriateness of epinephrine/adrenaline use in children identified as allergic by physicians in the emergency department (ED) at the time of the reaction, and to identify factors that are possibly associated with epinephrine/adrenaline administration, auto-injector prescription, and further referral to an allergist.

Methods: We performed a retrospective cross-sectional study at the pediatric ED of the University Hospital of Montpellier, France. We included all consecutive children who attended the ED between 2016 and 2020 with an allergy-related diagnosis at discharge.

Results: We included 1056 allergy-related visits, including 224 (21.2%) with a diagnosis of anaphylaxis at discharge; only 17.0% of them received an epinephrine/adrenaline injection, and 57.1% consulted an allergist after the acute episode. An auto-injector was prescribed to 63 (28.1%) patients at discharge from the ED. Besides the severity of the clinical presentation, factors associated with a guidelines-based management of the anaphylactic reaction and with an increased administration rate of epinephrine/adrenaline included presence of asthma symptoms and presence of extended skin reactions.

Conclusions: Our study underlines persistent gaps in the management of pediatric anaphylaxis in ED, focusing on hereby identified levers. By disseminating current knowledge and guidelines on anaphylaxis and allergies, specialists could work together with emergency physicians to establish effective management algorithms and improve anaphylaxis management and care pathways for children experiencing allergic reactions, especially anaphylaxis.

Trail registration: Clinical Trials, number NCT05112367.

Keywords: anaphylaxis; children; emergency department; epinephrine/adrenaline; treatment.

FIGURE 1

Patients included in our study, Venn diagram. The total number of patients identifies those with the International Classification of Diseases (ICD‐10) diagnosis possibly evocative of an allergic reaction. The two subgroups are composed of children experiencing an allergic reaction and an anaphylactic one, based on an examination of data from their medical charts.

FIGURE 2

Appropriateness of epinephrine/adrenaline administration to children with allergist–confirmed anaphylaxis in the pediatric emergency department (ED) of Montpellier, and of its prescription upon discharge from the ED. EAI: epinephrine/adrenaline auto‐injector; CI: confidence interval (CI).