World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings.
BACKGROUND
The availability of anaphylaxis guidelines and of medications, supplies, and equipment for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings worldwide is unknown.


OBJECTIVE
To ascertain the global availability of these essentials.


METHODS
A survey instrument was developed and sent by e-mail in 2008 to a nonrandomized convenience sample of representative leading allergy-immunology specialists in 52 countries identified through the World Allergy Organization. Responses were analyzed by country.


RESULTS
Surveys were returned from 44 of 52 countries on 6 continents, for an 85% response rate. Anaphylaxis guidelines were reported to be in use in 70% of the 44 responding countries. The diagnosis of acute anaphylaxis was reported to be based on clinical history and physical examination alone in 63% of responding countries. Medications for anaphylaxis treatment were reported to be available in the 44 responding countries as follows: epinephrine (adrenaline) for injection, 100%; any intravenous glucocorticoid, 89%; any intravenous H1-antihistamine, 77%; any intravenous H2-antihistamine, 70%; glucagon, 73%; atropine, 73%; dopamine, 86%; noradrenaline, 70%; vasopressin, 64%; and a beta 2-agonist for nebulization, 86%. Supplies and equipment for anaphylaxis treatment were reported to be available in responding countries as follows: for giving supplemental oxygen, 95%; for intubation, 89%; for giving intravenous fluid resuscitation, 91%; for monitoring oxygenation using pulse oximetry, 91%; and for continuous noninvasive blood pressure and cardiac monitoring, 81%.


CONCLUSIONS
Allergy-immunology specialists reported that except for epinephrine ampules life-saving essentials for the assessment and management of anaphylaxis in health care settings were not universally available worldwide in 2008.
Simons
F Estelle R
FE
Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. lmcniven@hsc.mb.ca
D000707:Anaphylaxis / Q000175:diagnosis* / Q000628:therapy*; D018926:Anti-Allergic Agents / Q000600:supply & distribution; D018927:Anti-Asthmatic Agents / Q000600:supply & distribution; D004837:Epinephrine / Q000600:supply & distribution; D004864:Equipment and Supplies / Q000600:supply & distribution; D014943:Global Health; D019538:Health Care Surveys; D006801:Humans; D054538:Occupational Health Physicians / Q000592:standards*; D010100:Oxygen / Q000600:supply & distribution; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011364:Professional Practice / Q000706:statistics & numerical data*
D018926:Anti-Allergic Agents; D018927:Anti-Asthmatic Agents; D010100:Oxygen; D004837:Epinephrine