title: Adrenaline in anaphylaxis treatment and self-administration: experience from an inner city emergency department.
abstract: BACKGROUND
  Anaphylaxis is a life-threatening emergency of which reliable epidemiological data are lacking. This study aimed to analyze how quickly patients presenting with anaphylaxis were treated in emergency and whether treatment followed the European Academy of Allergy and Clinical Immunology (EAACI) guidelines.
  
  
  METHODS
  Patient data were collected between April 2009 and April 2013. Emergency doctors completed a questionnaire for adult patients presenting at the emergency department (ED) of the St. Pierre hospital in Brussels with anaphylaxis. Inclusion criteria were based on the Sampson criteria of anaphylaxis. Data were analyzed using a Microsoft Excel database.
  
  
  RESULTS
  About 0.04% (100/230878) of all emergency visits in adults presented with anaphylaxis. 64% of patients received their first medical help later than 30 min after symptom onset. 67% of patients received adrenaline, 85% oral antihistamines, and 89% received IV glucocorticosteroids. 46/100 patients were discharged directly from the ED, of which 87% received further medical prescriptions for self-administration: 67% corticosteroids, 83% antihistamines, and 9% intramuscular adrenaline. 74% were instructed to consult an allergologist for adequate diagnosis. 54/100 patients were hospitalized.
  
  
  CONCLUSIONS
  The majority of patients were treated according to the EAACI guidelines for management of anaphylaxis, but only a minority received the recommended adrenaline auto-injector for self-administration at discharge. Because the majority of patients received medical help later than 30 min after symptom onset, adrenaline auto-injector prescription is a necessity. The low rate of doctors prescribing adrenaline auto-injectors in the ED setting underlines the need to train doctors of various backgrounds in prevention and treatment of anaphylaxis and the close collaboration with allergologists.
authors.affiliation: Department of Dermatology, Universitary Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Y
authors.initials: Y
authors.lastname: Mostmans
authors.affiliation: Department of Dermatology, Universitary Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Grosber
authors.affiliation: Department of Dermatology, Universitary Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Blykers
authors.affiliation: Service des Urgences et du SMUR, C.H.U. Saint-Pierre, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Mols
authors.affiliation: Clinic of Immuno-allergology, C.H.U. Brugmann, Brussels, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Naeije
authors.affiliation: Department of Dermatology, Universitary Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Gutermuth
mesh_terms: D000707:Anaphylaxis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D002947:Cities; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D017063:Outcome Assessment, Health Care; D012646:Self Administration; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D004837:Epinephrine
keywords: Belgium; adrenaline auto-injector; anaphylaxis; emergency department; management