Multicenter study of emergency department visits for insect sting allergy

ArticleinJournal of Allergy and Clinical Immunology 116(3):643-9 · October 2005with20 Reads
DOI: 10.1016/j.jaci.2005.06.026 · Source: PubMed
Abstract
An earlier study of food-related anaphylaxis in the emergency department (ED) suggested low concordance with national guidelines for anaphylaxis management. To extend these findings, we performed a chart review study to describe current ED management of insect sting allergy. The Multicenter Airway Research Collaboration performed a chart review study in 15 North American EDs. Investigators reviewed 617 charts of patients with insect sting allergy. Patients were identified by using International Classification of Diseases, 9th Revision, codes 989.5 (toxic effect of venom), 995.0 (other anaphylactic shock), and 995.3 (allergy, unspecified). The cohort was 42% female and 61% white, with a mean age of 36+/-19 years. In this cohort, 58% had local reactions, 11% had mild systemic reactions, and 31% had anaphylactic reactions, as defined by multisystem organ involvement or hypotension. Among patients with systemic reactions (mild or anaphylaxis), most (75%) were stung within 6 hours of ED arrival. While in the ED, 69% of systemic reaction patients received antihistamines, 50% systemic corticosteroids, and 12% epinephrine. Almost all systemic reaction patients (95%) were discharged to home. At ED discharge, 27% (95% CI, 22% to 33%) of systemic reaction patients received a prescription for self-injectable epinephrine. Only 20% (95% CI, 15% to 26%) had documentation of referral to an allergist. Although guidelines suggest specific approaches for the emergency management of insect sting allergy, concordance with these guidelines appears low in patients with a severe insect sting reaction.
    • "Within residents of Constanța County category, we further divided the records in two more groups, namely urban areas (for residents of Băneasa, Constanța, Eforie, Medgidia, Murfatlar, Năvodari, Negru Vodă, Ovidiu and Techirghiol) and rural areas, all of the remaining records. For the purpose of this study, following the general suggestions of Bilo et al. (2005) and Clark et al. (2005), we divided the outcome of the stings/bites in two categories: local and systemic reactions. We considered local reactions as skin rash, hives, or swelling, while systemic reactions included components of the skin, gastrointestinal, respiratory, renal and/or cardiovascular systems. "
    [Show abstract] [Hide abstract] ABSTRACT: Little is known about the prevalence and severity of allergic reactions caused by terrestrial arthropods in Romania although bites and stings of arthropods represent a widely recognized public health issue. We conducted a retrospective study in Constanța, the largest city at the Romanian Black Sea coast, and documented 207 cases during 2013–2014, representing 0.5% of the total number of records at the Emergency Department of the County Clinical Emergency Hospital. Young men and women presented themselves more often to the hospital to report this type of injuries and most arthropods causing allergic reactions were not identified. Our study brings novel information on the prevalence of injuries inflicted by terrestrial arthropods on the human adult population at the Romanian Black Sea coast, it highlights existing knowledge gaps and provides information on which to base future guidelines.
    Full-text · Article · Nov 2015
    • "Nonetheless, on a global level, evidence continues to point to both practice and knowledge gaps for emergency health professionals, including low concordance with guideline-recommended treatment, even in patients who were clearly diagnosed with anaphylaxis by medical record or by ICD-9 code. [2,891011121314151617 To date, only one study has evaluated the implementation of anaphylaxis guideline recommendations. [16] That study, performed using the transnational anaphylaxis registry of Germany, Austria, and Switzerland, confi rmed major discrepancies in treatment and follow-up and recommended a revised approach to management, including training and education. "
    [Show abstract] [Hide abstract] ABSTRACT: BACKGROUND: Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers. The study aimed to evaluate how emergency departments (EDs) in the United States (US) manage anaphylaxis in relation to guideline recommendations. METHODS: This was an online anonymous survey of a random sample of EM health providers in US EDs. RESULTS: Data analysis included 207 EM providers. For respondent EDs, approximately 9% reported using agreed-upon clinical criteria to diagnose anaphylaxis; 42% reported administering epinephrine in the ED for most anaphylaxis episodes; and <50% provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge. Most provided some written materials, and follow-up with a primary care clinician was recommended. CONCLUSIONS: This is the first cross-sectional survey to provide “real-world” data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine. Prospective research is recommended.
    Full-text · Article · Mar 2013
    • "Our hospital is located in an urban area with few beekeepers, hence the low incidence of Hymenoptera anaphylaxis in our series. Another difference between our series and other series published to date is the high incidence of Anisakis anaphylaxis, a subtype that has not been reported in series outside Spain [2,10111213141516171819202122. Anaphylaxis due to Anisakis has been reported by Spanish researchers [31], especially in regions of Spain where ingestion of uncooked fi sh is more frequent [30]. "
    [Show abstract] [Hide abstract] ABSTRACT: The absence of large-scale international studies means that data on anaphylaxis in emergency departments in different geographic areas are still necessary. To determine the incidence of anaphylaxis and subtypes of anaphylaxis and their distribution by age group in the emergency department of Hospital Universitario Fundación Alcorcon, Alcorcon (Madrid), Spain. Our study was performed between 2004 and 2005. We used the definition of anaphylaxis established by the NIAID-FAAN Symposium. Patient information was collected from the electronic clinical records of the emergency department using alphanumeric strings to identify acute allergic illnesses. This strategy recovered 91.7% of all anaphylaxis episodes in a pilot study. We observed a crude cumulative incidence of 0.9 episodes of anaphylaxis per 1000 emergency episodes (95% confidence interval [CI], 0.8-1.1), and 0.8 episodes per 1000 people (95% CI, 0.7-0.9). Standardized cumulative incidence of anaphylaxis according to the Standardized European Population was 1.1 (95% CI, 0.9-1.2). On analyzing the 213 cases of anaphylaxis, we discovered that the main cause was food (28.6%), followed by drugs (28.2%), unknown causes (27.2%), Anisakis (10.8%), Hymenoptera venom (3.3%), exercise (2.4%), and latex (0.9%). Food-induced anaphylaxis was less frequent in all groups older than the 0-4 age group in both reference populations (people who attend the emergency department and the general population). The cumulative incidence of anaphylaxis in our emergency department is low. Anaphylaxis by foods is more frequent in the 0-4 year group than in the other age groups. Drugs and food are the most frequent causes of anaphylaxis in our emergency department.
    Full-text · Article · Jan 2011
Show more

Recommended publications

Discover more