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More adrenaline for anaphylaxis over the last decade?

Rueter, K., Ta, B., Bear, N., Lucas, M., Borland, M.L. and Prescott, S.L. (2018) More adrenaline for anaphylaxis over the last decade? Internal Medicine Journal, 48 (S6). p. 15.

Free to read: https://doi.org/10.1111/imj.37_14077
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Abstract

Background
We recently determined that allergy training programs have improved physician recognition and diagnosis of pediatric anaphylaxis in the last decade.1 Here we investigated whether this has led to changes in management, in particular increased appropriate use of adrenaline for the treatment of anaphylaxis in a major tertiary Paediatric Emergency Department (PED) in the Perth metropolitan area.

Methods
We conducted a retrospective case note study including children 0‐16 years coded and verified for anaphylaxis in the years 2003/2004 and 2012. Standardized information was collected on clinical presentation, demographics, vital signs, mode of transport and management of anaphylaxis including the use of adrenaline and/or adjunct therapy. Follow‐up arrangements were also recorded.

Results
92/83832 of PED‐presentations were coded and verified for anaphylaxis in 2003/2004 compared to 159/71822 in 2012. A significantly higher proportion of cases were appropriately managed with adrenaline in 2012 compared to prior to the introduction of training programs, in 2003/2004 (P = 0.03). This change was predominantly driven by the prescribing practices of PED physicians and the improved recognition of anaphylaxis. Vital signs were more frequently documented in 2012 (P < 0.001) than in 2003/2004, and there was significantly less administration of other medications (corticosteroids, bronchodilators, antihistamines) (P < 0.05). Also changes in discharge management occurred with an improved dispensing/prescription of adrenaline‐autoinjectors and follow‐up arrangement with specialist allergy services (P < 0.001) in 2012.

Conclusion
There was a significant improvement in the management of anaphylaxis over this 10‐year period. This appeared to be related to an intensified physician training program and highlights the importance of cooperation between paediatric emergency and allergy services.

Item Type: Journal Article
Murdoch Affiliation: Institute for Immunology and Infectious Diseases
Publisher: Blackwell Publishing
Copyright: © 2018 Royal Australasian College of Physicians.
Other Information: Poster from: ASCIA 2018 Conference, 29th Annual Conference of the Australasian Society of Clinical Immunology and Allergy (ASCIA), 4–8 September 2018, National Convention Centre, Canberra ACT Australia
URI: http://researchrepository.murdoch.edu.au/id/eprint/42736
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