Children Not Getting Epinephrine When Needed, Prior to Arriving at ED

In a very interesting study, the routine use of epinephrine for anaphylaxis was analyzed. It was found that less than half of children presenting to emergency departments for acute anaphylaxis were administered epinephrine before arriving to the hospital, though a majority of these patients had been previously prescribed epinephrine autoinjectors (EA).1 Epinephrine is the first line treatment for acute anaphylaxis (severe allergic reaction), and should be administered as soon as possible.2 Individuals with a history of anaphylaxis should be prescribed an EA, and be familiar with its use, and when to use it.

Anaphylaxis is a Serious Concern and Possibly Fatal

Anaphylaxis is a serious concern and can cause death through acute respiratory obstruction, causing asphyxiation.

The study looked at 408 children seen at an emergency department (ED) or urgent care (UC) for anaphylaxis. Records confirmed that less than 50% of those children were given epinephrine prior to their arrival, even though approximately 65% had a history of anaphylaxis and 47% had an EA prescription. The study found that children who had presenting symptoms at school were more likely to receive epinephrine than those who had severe allergic reactions at home.

The conclusions of this study are that many aspects of proper epinephrine use need to be communicated to patient populations with a history of anaphylaxis, and EA prescriptions.

From another recent publication, some education points include:2

  1. Prompt diagnosis of anaphylaxis

  2. Comfortability and instruction on administration of intramuscular epinephrine (prompt IM EA injection in anterio-lateral thigh reduces hospitalizations and death)

  3. Prescribing EAs to patients with a history of anaphylaxis, or those at high risk

  4. Management of anaphylaxis in community settings, including school, preschools, camps, and sports settings

  5. Isolation and avoidance of allergic triggers

Sources

  1. Chooniedass R, Temple B, Becker A. Epinephrine use for anaphylaxis: Too seldom, too late: Current practices and guidelines in health care. Ann Allergy Asthma Immunol. 2017;
  2. Sicherer SH, Simons FER. Epinephrine for First-aid Management of Anaphylaxis. Pediatrics. 2017;139(3)
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Node Smith, associate editor for NDNR, is a fifth year naturopathic medical student at NUNM, where he has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine among the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend camp out where naturopathic medicine and medical philosophy are experienced in nature. Three years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision. 

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