New Studies Reveal Anaphylaxis Mismanagement Among Patients and EMS

In Boston on October 24, 2024, two new studies presented at the American College of Allergy, Asthma, and Immunology (ACAAI) Annual Scientific Meeting shed light on the critical misunderstandings surrounding anaphylaxis management, not only among patients and caregivers but also among emergency medical professionals. Anaphylaxis is a severe, potentially life-threatening allergic reaction that can escalate suddenly. If not treated correctly and promptly, it can lead to fatal outcomes, making education on proper treatment protocols essential.

According to Sasha Alvarado, DO, Co-Director of Quality and Safety for the Division of Immunology, Allergy, and Retrovirology at Baylor College of Medicine, “We know early recognition of anaphylaxis and treatment with epinephrine improves outcomes.” Despite this, both patients and medical professionals often fail to follow correct treatment guidelines, leading to suboptimal outcomes in the management of severe allergic reactions.

The first study, led by Joni Chow, DO, a Pediatric Resident at Baylor College of Medicine, involved a survey of 96 patients and caregivers in an allergy clinic waiting room. The goal was to evaluate their understanding of anaphylaxis and the key elements of an anaphylaxis action plan. The study found that although 95.8% of respondents were prescribed epinephrine, a mere 14% said they were highly likely to use epinephrine as the first line of treatment in an anaphylactic emergency. This suggests a serious gap in patient education and confidence, despite the high stakes of anaphylaxis. Chow highlighted the importance of better educating allergy patients on how to recognize anaphylaxis and respond with epinephrine quickly.

Several barriers to using epinephrine were identified in the study, including uncertainty about which symptoms warrant treatment (40.6%), hesitation to go to the emergency room (24%), reluctance to call 911 (17.7%), lack of confidence in using epinephrine auto-injectors (11.5%), and fear of needles (5.2%). These barriers suggest a widespread need for improved guidance and support for both patients and caregivers.

Furthermore, while most respondents expressed some level of comfort recognizing anaphylaxis symptoms (73%), their confidence in taking the appropriate next steps was notably low. Only 36.5% of those surveyed had an anaphylaxis action plan in place, and there was a clear desire for improved educational tools. Many respondents valued the inclusion of visuals in an action plan, with 87.6% favoring visuals demonstrating how to use epinephrine, and 81% finding visuals that depict anaphylaxis symptoms to be crucial.

In the second study, Carly Gunderson, DO, led a review of emergency medical services (EMS) protocols across 30 states to assess inconsistencies in how anaphylaxis is treated in the prehospital setting. The findings revealed significant gaps in the recognition and treatment of anaphylaxis, which could negatively impact patient outcomes. While all 30 states recommended the use of epinephrine and diphenhydramine for anaphylaxis, only 47% of states used a two-organ system definition, and even fewer included gastrointestinal (50%) or neurological (40%) symptoms in the definition of anaphylaxis. This suggests that many EMS professionals may overlook key indicators of severe allergic reactions, which could delay appropriate treatment.

Moreover, while 97% of EMS protocols recommended epinephrine as the first line of treatment, only 83% of states permitted the use of epinephrine auto-injectors, and a mere 57% provided them. The study authors were particularly concerned by the fact that many protocols did not account for gastrointestinal or neurological manifestations, which are important indicators of anaphylaxis. Additionally, outdated recommendations, such as the use of first-generation antihistamines and steroids, persisted in several protocols.

Gunderson emphasized the need for updated, standardized EMS protocols based on current evidence-based guidelines. This would ensure that EMS professionals across the United States are better equipped to recognize and treat anaphylaxis promptly and appropriately, potentially reducing the risk of fatal outcomes. The lack of consistency across state protocols highlights the ongoing challenge in providing standardized care for anaphylaxis patients, particularly in emergency settings.

Both studies underscore the critical need for improved education and protocols when it comes to managing anaphylaxis. For patients and caregivers, the creation of a well-designed, patient-centered action plan, including visual aids and clear instructions for using epinephrine, could lead to more confident and effective management of allergic reactions. Meanwhile, for emergency medical personnel, ensuring that protocols are up-to-date and comprehensive can help save lives by promoting faster and more accurate recognition and treatment of anaphylaxis in prehospital settings.

The ACAAI Annual Scientific Meeting, held from October 24-28, 2024, brings together experts in allergy, asthma, and immunology to discuss the latest research and developments in the field. Both studies presented at this year’s conference highlight the importance of early intervention and proper treatment protocols in managing anaphylaxis, offering valuable insights into how both healthcare professionals and patients can improve outcomes for those at risk of severe allergic reactions.

For more information about anaphylaxis, and to find an allergist near you, visit the American College of Allergy, Asthma, and Immunology (ACAAI) at AllergyandAsthmaRelief.org. The ACAAI, established in 1942, is dedicated to advancing patient care through research, education, and collaboration among allergists and healthcare professionals.

Reference:

1. https://acaai.org/news/anaphylaxis-treatment-remains-confusing-for-patients-caregivers-and-emergency-personnel/

(Input from various sources)

(Rehash/Yash Kamble/MSM)