title: Implementation of anaphylaxis management guidelines: a register-based study.
abstract: BACKGROUND
  Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines.
  
  
  METHODS
  Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data.
  
  
  RESULTS
  2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time.
  
  
  CONCLUSIONS
  There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted.
authors.affiliation: Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre Berlin, Berlin, Germany.
authors.forename: Linus
authors.initials: L
authors.lastname: Grabenhenrich
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hompes
authors.forename: Hannah
authors.initials: H
authors.lastname: Gough
authors.forename: Franziska
authors.initials: F
authors.lastname: Ruëff
authors.forename: Kathrin
authors.initials: K
authors.lastname: Scherer
authors.forename: Claudia
authors.initials: C
authors.lastname: Pföhler
authors.forename: Regina
authors.initials: R
authors.lastname: Treudler
authors.forename: Vera
authors.initials: V
authors.lastname: Mahler
authors.forename: Thomas
authors.initials: T
authors.lastname: Hawranek
authors.forename: Katja
authors.initials: K
authors.lastname: Nemat
authors.forename: Alice
authors.initials: A
authors.lastname: Koehli
authors.forename: Thomas
authors.initials: T
authors.lastname: Keil
authors.forename: Margitta
authors.initials: M
authors.lastname: Worm
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000707:Anaphylaxis / Q000175:diagnosis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D004632:Emergency Medical Services; D004837:Epinephrine / Q000008:administration & dosage; D005060:Europe; D005260:Female; D019983:Guideline Adherence; D006633:Histamine Antagonists / Q000008:administration & dosage; D006801:Humans; D020407:Internet; D008297:Male; D017410:Practice Guidelines as Topic; D012042:Registries; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D006633:Histamine Antagonists; D004837:Epinephrine