2 New Studies Highlight Issues with Treatment of Anaphylaxis

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In 2 new analyses which were presented at the 2024 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting, investigators reported that patients, caregivers, and even emergency medical professionals often follow the wrong protocols for severe allergic reactions such as anaphylaxis.¹

These findings presented in these 2 studies highlight the importance many place on ensuring proper treatment of anaphylaxis. Recent findings on the ‘Parental Self-efficacy in Managing Anaphylaxis (PSEMA)’ questionnaire tool for assessing caregivers’ self-efficacy in the managing of childrens’ anaphylaxis and adrenaline via auto-injector further highlight the current push for greater awareness of anaphylaxis management.²

Study 1 Background and Findings

In the first of the 2 studies presented at ACAAI was titled ‘Understanding of Anaphylaxis Management Among Allergy Patients and Components of a Patient-Centered Anaphylaxis Action Plan.’ This study was presented by Joni Chow, DO, a pediatric resident at Baylor College of Medicine in San Antonio.¹

In this analysis, the research team had developed a survey instrument which evaluated awareness of anaphylaxis and looked into components of an anaphylaxis action plan which would be sought after. The survey was completed within an allergy clinic waiting room by 96 patients and caregivers.

Reports among 95.8% of survey participants suggested that they had been prescribed epinephrine. However, it was noted that although 73% of the subjects expressed feeling somewhat or very confident in their identifying symptoms, only 14% of respondents could accurately identify those that would necessitate administering epinephrine.

The analysis also concluded that 85% comprehended that antihistamines were not a substitute for epinephrine, though 23.7% were still found to have a preference for antihistamine use initially in the case of an anaphylactic reaction.

64.5% of survey respondents suggested that, in scenarios during which both rash and wheezing followed allergen exposure, they would use epinephrine. The investigators also found that only 10.8% indicated that they would opt to drive to the emergency room prior to injections.

The study also highlighted several different barriers subjects noted as preventing epinephrine use, some of which were the following: 11.5% expressed uncertainty in using an auto-injector, 40.6% in identifying symptoms requiring treatment, 5.2% expressed having a fear of needles, 17.7% expressed reluctance in asking for emergency services, and 24% noted hesitancy in emergency room visits.

“We surveyed 96 patients and caregivers in an allergy clinic waiting room to evaluate knowledge of anaphylaxis and desired components of an anaphylaxis action plan,” Chow said in a statement. “The results demonstrate the need for better education of allergy patients to recognize and treat anaphylaxis appropriately.”’

Study 2 Background and Findings

The second study presented at the conference was titled 'Discrepancies in Anaphylaxis Protocols Across Emergency Medical Services in the United States - Opportunities for Improvement.’ It was led by Carly Gunderson, DO.

“Many EMS anaphylaxis protocols are incomplete and/or outdated,” Gunderson said in a statement. “The discrepancies include variations in the definition of anaphylaxis as well as in treatment.”

Gunderson and colleagues had conducted an assessment of statewide anaphylaxis protocols, with their aim being the isolation of gaps in recognition of anaphylaxis. The research team also sought to provide notes for improvement in cases of prehospital management.

During their analysis, the team included 30 states which had mandatory or model state-wide Advanced Cardiac Life Support (ACLS) protocols. The investigators reviewed each of the allergic reactions and/or anaphylaxis protocols throughout their research.

They concluded that among these 30 states, only half included gastrointestinal symptoms as a portion of their anaphylaxis definition. The research team added that only 40% of them included neurologic symptoms within their criteria and 47% used a 2-organ system approach for their anaphylactic reaction definition.

In terms of protocols for treatment protocols, all states were shown by the team to have urged utilizing both diphenhydramine and epinephrine for anaphylaxis. They also reported that 90% included an advisement for albuterol for respiratory symptoms and that 73% urged administering intravenous fluids.

Additionally, the investigators found that 60% had written steroids into their protocols. They found that 97% highlighted epinephrine as their first-line treatment for anaphylaxis and that 83% of the states they assessed allowed the use of epinephrine auto-injectors.

References

1. ^{Anaphylaxis Treatment Remains Confusing for Patients, Caregivers and Emergency Personnel. Presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting 2024. October 24, 2024. https://www.newswise.com/articles/anaphylaxis-treatment-remains-confusing-for-patients-caregivers-and-emergency-personnel. Date accessed: November 8, 2024.}
2. ^{Smith T. Tool Used to Assess Parents’ Management of Child Anaphylaxis, Autoinjector Administration. HCPLive. November 8, 2024. https://www.hcplive.com/view/tool-used-assess-parents-management-child-anaphylaxis-autoinjector-administration.}