Newswise — New preliminary research findings show frontline healthcare providers are not following guidelines on the management of anaphylaxis, a severe allergic reaction, according to findings presented during the Annual Meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Anaheim.
Patients with a history of a anaphylaxis to an insect sting should be educated on ways to avoid insect stings, carry injectable epinephrine for emergency self treatment, undergo specific IgE testing for stinging insect sensitivity and be considered for immunotherapy according to guidelines published by The Joint Task Force of Allergy, Asthma and Immunology of the ACAAI and the American Academy of Allergy, Asthma and Immunology (AAAAI).
According to Thomas L. Johnson, II, M.D., San Antonio, Texas, and colleagues, this retrospective chart review performed on 769 patients treated at emergency room and primary care clinic visits is the first study to directly review frontline providers' documented recommendations for fire ant and flying insect hypersensitivity reactions.
In the abstract titled "Management of Insect Hypersensitivity: A 5 Year Chart Review," of the 120 encounters that were suggestive of a systemic reaction, 59 of them came from flying hymenoptera and 46 came from fire ants. The remainder of the systemic reactions came from five scorpion stings or from 10 visits that did not specify an insect.
Only 55 percent of the patients that had a systemic reaction received a prescription for injectable epinephrine, 12 percent were given information regarding avoidance of the offending insect, and 39 percent were referred to an allergist. Of the 28 patients who were referred to an allergist, kept their appointments and were tested, 89 percent had positive skin testing and were recommended to start immunotherapy.
Authors conclude, "it is apparent that many patients who have experienced a systemic reaction following an insect sting and have sought medical care are not afforded an opportunity for potentially live saving therapy."
In another investigation titled "Management of Hymenoptera Reactions in a Pediatric Population," during emergency department visits by children diagnosed with anaphylaxis due to insect venom, researchers found that no instructions were given to any patients for avoidance measures.
This retrospective review of 91 patient charts by Anardi Augusto, M.D., and Sujatha Ramesh, M.D., at Women & Children's Hospital of Buffalo in Buffalo, N.Y., found that although systemic reactions were managed appropriately, the majority of patients were not referred to an allergist. A significant percentage of the local reactions had inappropriate prescriptions for EpiPen and antibiotics (both 14 percent).
A third study titled "Anaphylaxis, a Review of Emergency Department Management and Discharge Planning" reviewed practices for 65 anaphylaxis cases in a city and suburban hospital ED. Investigators Fariba Rezaee, M.D., and Joel Mendelson, M.D., Newark, N.J., did not find any significant differences between the two hospitals, but concluded that "in spite of published guidelines for management of anaphylaxis it appears the use of EpiPen on discharge from ED is not universal."
Epinephrine auto-injectors are life-saving devices designed for emergency use outside healthcare facilities. In a fourth study titled "Adrenaline Auto-Injectors: Knowledge Survey and Opinion Poll on Device Design," investigators Sharon Leonard, M.D., and Thomas G. Westbrook, M.D., Pensacola, Fla., evaluated patients' and clinicians' knowledge and opinions on auto-injectable devices.
Conducting a 4-year retrospective chart review and survey of patients seen in the ED who received an EpiPen prescription, they found that the majority of patients were not aware that GI symptoms often occurred with anaphylaxis, did not recognize signs of cardiovascular collapse, or know when the medication was spoiled.
Among local health care professionals, 46 percent gave a demonstration or provided written materials. Only 12 percent of pharmacists routinely demonstrated the use of the EpiPen, leading authors to conclude that "prescribers are responsible for educating patients about the device and should not assume pharmacists provide the needed education."
"In patients with a history of anaphylaxis, it is apparent from this study that additional educational material needs to be reviewed with each patient. Not only do they need to know how to use their auto-injector, but they also need to know about the various symptoms and signs that might indicate that a anaphylactic reaction is occurring," Dr. Westbrook said.
Patient information on allergic diseases and anaphylaxis is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at http://www.acaai.org, or the Food Allergy & Anaphylaxis Network (FAAN) at http://www.foodallergy.org.
The ACAAI is a professional medical organization, headquartered in Arlington Heights, Ill., comprising nearly 5,000 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.
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