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Many Anaphylactic Children Don’t Receive Epinephrine Before ED Visit

This probably is no surprise to clinicians who see it all the time, but many children present to the emergency department with severe allergic reactions without having received a dose from their epinephrine auto injector.

That’s according to a new study published in the Annals of Allergy, Asthma and Immunology. The situation is similar for pediatric patients visiting urgent care centers (UCC), the study noted.

In fact, among the patient group analyzed — mostly boys with an average age of about 7 years old — only 36.3% received epinephrine before arrival at the ED or UCC.

To reach that conclusion, researchers at National Jewish Hospital reviewed 408 patient records for children seen in an ED or UCC. Most of the patients, 65%, had a history of anaphylaxis, and 47% had been previously prescribed epinephrine.

The study found that children having a reaction at home were less likely to receive epinephrine than those having a reaction at school, notes lead author Melissa Robinson, DO. Parents or caregivers often delay or avoid treating children with epinephrine even though it is the first-line treatment for anaphylaxis, says co-author David Stukus, MD, of Nationwide Children’s Hospital in Cincinnati, OH.

The odds of receiving epinephrine before arrival at the ED or UCC were significantly lower with a two-organ system (OR, 0.50) or three-organ system (OR, 0.41) presentation compared with one-organ system involvement, according to the report. Researchers note that this finding is illogical, and they suggest that future study could help better understand contributing factors. The study found the most common trigger was food of some type.

Overall, about 50% of children with severe allergic reactions got epinephrine, study authors point out. That figure includes both those who had received it before seeking medical care and those given a shot at the hospital or clinic.

The study wasn’t powered to determine why more children weren’t treated with the life-saving drug, but researchers found that patients who received epinephrine prior to arrival were also more likely to be discharged home compared with those who didn't.

The study found that only two-thirds of children who previously had an epinephrine prescription had their auto injector available at the time of the allergic reaction.