title: Allergists' self-reported adherence to anaphylaxis practice parameters and perceived barriers to care: an American College of Allergy, Asthma, and Immunology member survey.
abstract: BACKGROUND
  Anaphylaxis is life-threatening and requires rapid medical intervention. Knowledge of treatment guidelines and addressing barriers to care are essential for appropriate management.
  
  
  OBJECTIVE
  To investigate allergists' self-reported practices in managing patients at risk for anaphylaxis, specifically in following practice parameters for diagnosis, treatment, and appropriate use of epinephrine, and to identify perceived barriers to care.
  
  
  METHODS
  Online questionnaires were distributed to members of the American College of Allergy, Asthma, and Immunology. The US physicians who self-identified as "allergist/immunologist" were eligible to participate. The first 500 completed questionnaires were analyzed.
  
  
  RESULTS
  Nearly all (≥95%) reported adherence to practice parameters in prescribing an epinephrine auto-injector and instructing patients on its use, taking a detailed allergy history, counseling patients on avoidance measures, and educating patients on the signs and symptoms of anaphylaxis. More than 90% stated they determined the best diagnostic procedures to identify triggers and coordinated laboratory and allergy testing. Adherence to practice parameters was less robust for providing patients with written action plans and in-office anaphylaxis preparedness. Perceived barriers to care included a significant proportion of patients who were uncomfortable using epinephrine auto-injectors and inadequate knowledge of anaphylaxis among referral physicians.
  
  
  CONCLUSIONS
  Allergists overwhelmingly adhere to practice parameter recommendations for the treatment and management of anaphylaxis, including appropriate use of epinephrine as first-line treatment, educating patients, and testing to diagnose anaphylaxis and identify its triggers. Opportunities for improvement include preparing staff and patients for anaphylactic events, providing written action plans, and improving knowledge of referring physicians.
authors.affiliation: Emory University School of Medicine and Atlanta Allergy and Asthma Clinic, Atlanta, Georgia.
authors.forename: Stanley
authors.initials: S
authors.lastname: Fineman
authors.forename: Paul
authors.initials: P
authors.lastname: Dowling
authors.forename: Dianne
authors.initials: D
authors.lastname: O'Rourke
mesh_terms: D000486:Allergy and Immunology; D000707:Anaphylaxis / Q000175:diagnosis / Q000628:therapy; D001993:Bronchodilator Agents / Q000008:administration & dosage; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012955:Societies, Medical; D013038:Specialization; D011795:Surveys and Questionnaires
chemical_list: D001993:Bronchodilator Agents; D004837:Epinephrine