EDs face ‘knowledge gap’ in use of epinephrine

A study conducted in one New York ED demonstrated a “knowledge gap” in pediatricians’ use of epinephrine for anaphylaxis, researchers reported at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

Mansi Kothari, MD, an allergist/immunologist at SUNY Downstate Medical Center in Brooklyn, and colleagues conducted a retrospective chart review that identified demographic and clinical characteristics of anaphylactic patients in the ED over 4 years.

They examined data on pediatric patients treated for anaphylaxis, allergic reactions not otherwise specified, allergic urticaria and angioedema from 2016 to 2019. The researchers then looked at each patient’s chart to determine whether they met the clinical criteria for anaphylaxis.

Kothari and colleagues identified 97 cases (0.2%) that met the criteria for anaphylaxis. More than a quarter of those patients (28.8%, n = 28) also had underlying asthma, whereas seven had atopic dermatitis and more than half (53.6%, n = 52) had a history of food allergies.

According to the researchers’ data, just more than a quarter (28.7%, n = 27) of the patients received epinephrine in the ED, whereas EpiPen was prescribed to 70% (n = 64) of patients at discharge.

For hospitalizations, 71.7% (n = 33) of patients with food-induced anaphylaxis received an EpiPen prescription and 30% (n = 27) of patients were referred to an allergist at discharge.

“There is a knowledge gap in pediatricians’ use of epinephrine for management of anaphylaxis in both ED and outpatient care,” the authors wrote.