Two new studies presented at the 2024 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting highlight significant gaps in anaphylaxis treatment protocols among patients, caregivers, and even emergency medical services (EMS) personnel. The research indicates a widespread misunderstanding of appropriate anaphylaxis management, potentially leading to delayed or ineffective treatment.
Patient and Caregiver Understanding of Anaphylaxis
One study, led by Joni Chow, DO, from Baylor College of Medicine, surveyed 96 patients and caregivers in an allergy clinic waiting room to assess their knowledge of anaphylaxis and desired components of an anaphylaxis action plan. The survey revealed that while 95.8% of participants had been prescribed epinephrine, only 14% could accurately identify symptoms necessitating its administration. Although 85% understood that antihistamines were not a substitute for epinephrine, 23.7% still preferred using antihistamines as the initial treatment for an anaphylactic reaction. Furthermore, only 64.5% indicated they would use epinephrine if both rash and wheezing followed allergen exposure, and a mere 10.8% would opt for epinephrine injection before heading to the emergency room.
The study also identified barriers to epinephrine use, including uncertainty in using an auto-injector (11.5%), difficulty in identifying symptoms requiring treatment (40.6%), fear of needles (5.2%), reluctance to call emergency services (17.7%), and hesitancy to visit the emergency room (24%).
"The results demonstrate the need for better education of allergy patients to recognize and treat anaphylaxis appropriately," Chow stated.
Discrepancies in EMS Anaphylaxis Protocols
The second study, led by Carly Gunderson, DO, assessed statewide anaphylaxis protocols across EMS in the United States, aiming to identify gaps in anaphylaxis recognition and suggest improvements in prehospital management. The analysis included 30 states with mandatory or model statewide Advanced Cardiac Life Support (ACLS) protocols.
The researchers found that only half of the states included gastrointestinal symptoms as part of their anaphylaxis definition, 40% included neurologic symptoms, and 47% used a two-organ system approach for defining anaphylactic reactions. Regarding treatment protocols, all states recommended using both diphenhydramine and epinephrine for anaphylaxis, 90% advised albuterol for respiratory symptoms, and 73% recommended intravenous fluids. Additionally, 60% included steroids in their protocols. Epinephrine was highlighted as the first-line treatment in 97% of the states, and 83% allowed the use of epinephrine auto-injectors.
"Many EMS anaphylaxis protocols are incomplete and/or outdated," Gunderson noted. "The discrepancies include variations in the definition of anaphylaxis as well as in treatment."
These findings underscore the urgent need for standardized, comprehensive anaphylaxis management protocols and improved education for patients, caregivers, and healthcare professionals to ensure timely and effective treatment of this potentially life-threatening condition.
