title: Management and treatment of anaphylaxis in children: still too low the rate of prescription and administration of intramuscular epinephrine.
abstract: Despite it being well known that anaphylaxis is a severe life-threatening reaction requiring prompt management and treatment, this entity is still under-recognized and not correctly managed, above all in children. The aim of this study was to analyze the most frequent features of anaphylaxis in a pediatric population (n=65 patients) and to identify factors predicting more severe reactions. Among the 70 recorded episodes, food was the main culprit of anaphylaxis, and patients with a positive history for allergic asthma had more severe episodes (P=0.008). A self-injectable adrenaline was used only in 2 of the 70 episodes and none of the 50 episodes managed in the Emergency Department was treated with intramuscular adrenaline. Only 10/65 patients (15&#x0025;) had a prescription for an auto-injector prior to the first episode of anaphylaxis. The retrospective analysis of the risk factors potentially requiring an epinephrine auto-injector prescription before the first anaphylactic episode, showed that of the 55 patients without prescription, at least 10 (18&#x0025;) should have been provided with a device, according to the most recent guidelines. In conclusion, notwithstanding intramuscular adrenaline being the first-line treatment of anaphylaxis, many episodes are still undertreated and the risk of anaphylaxis is still under-estimated. More efforts should be made to promote the correct management of anaphylaxis among both healthcare-providers and patients.
authors.affiliation: Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola  Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Calamelli
authors.affiliation: Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola  Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Mattana
authors.affiliation: Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola  Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cipriani
authors.affiliation: Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola  Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ricci
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D012189:Retrospective Studies
chemical_list: D004837:Epinephrine