Investigation of the underuse of adrenaline (epinephrine) and prognosis among patients with anaphylaxis at emergency department admission
BackgroundAnaphylaxis is a potentially fatal condition; in severe cases of anaphylaxis, the cardiovascular system is often heavily involved. Adrenaline (epinephrine) is a cornerstone of the initial treatment of anaphylaxis. The use of epinephrine remains below expectations in clinical practice. Whet...
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1163817/full |
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| author | Yen-Yue Lin Yen-Yue Lin Yen-Yue Lin Hsin-An Chang Yung-Hsi Kao Chih-Pin Chuu Chih-Pin Chuu Wen-Fang Chiang Wen-Fang Chiang Ya-Chieh Chang Ya-Chieh Chang Yuan-Kuei Li Yuan-Kuei Li Chi-Ming Chu Chi-Ming Chu Chi-Ming Chu Chi-Ming Chu Jenq-Shyong Chan Jenq-Shyong Chan Po-Jen Hsiao Po-Jen Hsiao Po-Jen Hsiao Po-Jen Hsiao |
| author_facet | Yen-Yue Lin Yen-Yue Lin Yen-Yue Lin Hsin-An Chang Yung-Hsi Kao Chih-Pin Chuu Chih-Pin Chuu Wen-Fang Chiang Wen-Fang Chiang Ya-Chieh Chang Ya-Chieh Chang Yuan-Kuei Li Yuan-Kuei Li Chi-Ming Chu Chi-Ming Chu Chi-Ming Chu Chi-Ming Chu Jenq-Shyong Chan Jenq-Shyong Chan Po-Jen Hsiao Po-Jen Hsiao Po-Jen Hsiao Po-Jen Hsiao |
| author_sort | Yen-Yue Lin |
| collection | DOAJ |
| description | BackgroundAnaphylaxis is a potentially fatal condition; in severe cases of anaphylaxis, the cardiovascular system is often heavily involved. Adrenaline (epinephrine) is a cornerstone of the initial treatment of anaphylaxis. The use of epinephrine remains below expectations in clinical practice. Whether the underuse of epinephrine affects the prognosis of patients with anaphylaxis is still unclear.Materials and methodsThis retrospective study included patients with anaphylaxis between 2011 and 2020 who were admitted to an emergency department (ED) in Taiwan. All patients were divided into two groups based on the use of epinephrine (or not), and we compared the demographic characteristics, allergens, clinical manifestations, management, and patient outcomes.ResultsWe reviewed the records of 314 subjects (216 males, 98 females; mean age: 52.78 ± 16.02 years) who visited our ED due to anaphylaxis; 107 (34.1%) and 207 (65.9%) patients were categorized into the epinephrine use group and the non-epinephrine use group, respectively. Arrival via ambulance (p = 0.019), hypotension (p = 0.002), airway compromise (p < 0.001) and altered consciousness (p < 0.001) were the deciding factors for epinephrine use among anaphylactic patients in the ED. The epinephrine use group had higher rates of other inotropic agent usage and fluid challenge. More than 90% of patients received bed rest, steroids, antihistamines, and monitoring. The epinephrine use group had a longer ED length of stay (387.64 ± 374.71 vs. 313.06 ± 238.99 min, p = 0.03) and a greater need of hospitalization. Among all severe symptoms, hypotension was the most tolerated decision factor for not using epinephrine. In this retrospective analysis, some patients with serious anaphylaxis did not experience adverse outcomes or death even without the use of epinephrine at ED admission. Emergent care focuses first on the airway, breathing, and circulation (ABC) and may compensate for the underusage of epinephrine. This could be the reason why epinephrine was underused among patients with anaphylaxis in the ED.ConclusionIn summary, early ABC management continues to play an important role in treating patients with severe anaphylaxis, even when epinephrine is not immediately available in clinical scenarios. |
| first_indexed | 2024-03-13T00:51:38Z |
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| language | English |
| last_indexed | 2024-03-13T00:51:38Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-c5cd64c92d8649a6b46b2ae7bf7a98b32023-07-07T12:48:03ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-07-011010.3389/fmed.2023.11638171163817Investigation of the underuse of adrenaline (epinephrine) and prognosis among patients with anaphylaxis at emergency department admissionYen-Yue Lin0Yen-Yue Lin1Yen-Yue Lin2Hsin-An Chang3Yung-Hsi Kao4Chih-Pin Chuu5Chih-Pin Chuu6Wen-Fang Chiang7Wen-Fang Chiang8Ya-Chieh Chang9Ya-Chieh Chang10Yuan-Kuei Li11Yuan-Kuei Li12Chi-Ming Chu13Chi-Ming Chu14Chi-Ming Chu15Chi-Ming Chu16Jenq-Shyong Chan17Jenq-Shyong Chan18Po-Jen Hsiao19Po-Jen Hsiao20Po-Jen Hsiao21Po-Jen Hsiao22Department of Emergency, Taoyuan Armed Forces General Hospital, Taoyuan, TaiwanDepartment of Emergency, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Life Sciences, National Central University, Taoyuan, TaiwanDepartment of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Life Sciences, National Central University, Taoyuan, TaiwanInstitute of Cellular and System Medicine, National Health Research Institutes, Zhunan, TaiwanGraduate Program for Aging, China Medical University, Taichung, TaiwanDivision of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, TaiwanDivision of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, TaiwanDivision of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Colorectal Surgery, Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan0Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan1School of Public Health, National Defense Medical Center, Taipei, Taiwan2Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan3Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan4Department of Public Health, School of Public Health, China Medical University, Taichung, TaiwanDivision of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, TaiwanDivision of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Life Sciences, National Central University, Taoyuan, TaiwanInstitute of Cellular and System Medicine, National Health Research Institutes, Zhunan, TaiwanDivision of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, TaiwanDivision of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanBackgroundAnaphylaxis is a potentially fatal condition; in severe cases of anaphylaxis, the cardiovascular system is often heavily involved. Adrenaline (epinephrine) is a cornerstone of the initial treatment of anaphylaxis. The use of epinephrine remains below expectations in clinical practice. Whether the underuse of epinephrine affects the prognosis of patients with anaphylaxis is still unclear.Materials and methodsThis retrospective study included patients with anaphylaxis between 2011 and 2020 who were admitted to an emergency department (ED) in Taiwan. All patients were divided into two groups based on the use of epinephrine (or not), and we compared the demographic characteristics, allergens, clinical manifestations, management, and patient outcomes.ResultsWe reviewed the records of 314 subjects (216 males, 98 females; mean age: 52.78 ± 16.02 years) who visited our ED due to anaphylaxis; 107 (34.1%) and 207 (65.9%) patients were categorized into the epinephrine use group and the non-epinephrine use group, respectively. Arrival via ambulance (p = 0.019), hypotension (p = 0.002), airway compromise (p < 0.001) and altered consciousness (p < 0.001) were the deciding factors for epinephrine use among anaphylactic patients in the ED. The epinephrine use group had higher rates of other inotropic agent usage and fluid challenge. More than 90% of patients received bed rest, steroids, antihistamines, and monitoring. The epinephrine use group had a longer ED length of stay (387.64 ± 374.71 vs. 313.06 ± 238.99 min, p = 0.03) and a greater need of hospitalization. Among all severe symptoms, hypotension was the most tolerated decision factor for not using epinephrine. In this retrospective analysis, some patients with serious anaphylaxis did not experience adverse outcomes or death even without the use of epinephrine at ED admission. Emergent care focuses first on the airway, breathing, and circulation (ABC) and may compensate for the underusage of epinephrine. This could be the reason why epinephrine was underused among patients with anaphylaxis in the ED.ConclusionIn summary, early ABC management continues to play an important role in treating patients with severe anaphylaxis, even when epinephrine is not immediately available in clinical scenarios.https://www.frontiersin.org/articles/10.3389/fmed.2023.1163817/fullanaphylaxisanaphylactic reactionsallergic reactionsadrenaline (epinephrine)emergency department |
| spellingShingle | Yen-Yue Lin Yen-Yue Lin Yen-Yue Lin Hsin-An Chang Yung-Hsi Kao Chih-Pin Chuu Chih-Pin Chuu Wen-Fang Chiang Wen-Fang Chiang Ya-Chieh Chang Ya-Chieh Chang Yuan-Kuei Li Yuan-Kuei Li Chi-Ming Chu Chi-Ming Chu Chi-Ming Chu Chi-Ming Chu Jenq-Shyong Chan Jenq-Shyong Chan Po-Jen Hsiao Po-Jen Hsiao Po-Jen Hsiao Po-Jen Hsiao Investigation of the underuse of adrenaline (epinephrine) and prognosis among patients with anaphylaxis at emergency department admission Frontiers in Medicine anaphylaxis anaphylactic reactions allergic reactions adrenaline (epinephrine) emergency department |
| title | Investigation of the underuse of adrenaline (epinephrine) and prognosis among patients with anaphylaxis at emergency department admission |
| title_full | Investigation of the underuse of adrenaline (epinephrine) and prognosis among patients with anaphylaxis at emergency department admission |
| title_fullStr | Investigation of the underuse of adrenaline (epinephrine) and prognosis among patients with anaphylaxis at emergency department admission |
| title_full_unstemmed | Investigation of the underuse of adrenaline (epinephrine) and prognosis among patients with anaphylaxis at emergency department admission |
| title_short | Investigation of the underuse of adrenaline (epinephrine) and prognosis among patients with anaphylaxis at emergency department admission |
| title_sort | investigation of the underuse of adrenaline epinephrine and prognosis among patients with anaphylaxis at emergency department admission |
| topic | anaphylaxis anaphylactic reactions allergic reactions adrenaline (epinephrine) emergency department |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1163817/full |
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