In Brief | Critical Care, Anaesthesia & Emergency Medicine | Paediatrics & Neonatology
Early Epinephrine Use Reduces ICU Admissions in Children with Anaphylaxis
Time to read: 03:47
Time to listen: 07:45
Originally Published: 20 December 2024
Source: The Journal of Allergy and Clinical Immunology: In Practice
Type of article: In Brief
MedED Catalogue Reference: MPIB0021
Category:Emergency Medicine
Cross Reference: Paediatrics & Neonatoloy, Allergy
Keywords: allergy, anaphalyxix, critical care, emergency medicine, epiniepherine
Children with anaphylaxis who received epinephrine before going to the ED were significantly less likely to be admitted to the ICU.
This article is a review of recent studies originally published in the Journal of Allergy and Clinical Immunology: In Practice, 20 December 2024. This article does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information.
Study Purpose
The primary objective of this study was to assess whether the administration of outpatient epinephrine reduces hospital and ICU admissions in children with anaphylaxis.
The study also sought to compare the outcomes of patients who received outpatient epinephrine versus those who did not while accounting for confounding variables through PSM. Additionally, outpatient antihistamine use was analyzed as a negative control to ensure that observed effects were specific to epinephrine.
The researchers state that their knowledge is the first study that used PSM to establish the association between outpatient epinephrine and hospital outcomes in anaphylaxis.
Study Methodology
Data were collected both prospectively and retrospectively, encompassing demographics, severity of symptoms, comorbidities, and reaction locations.
Matching was performed in a 1:1 ratio using nearest-neighbour matching. The statistical analysis included chi-square tests for categorical variables and unpaired t-tests for continuous variables using R software.
Findings
1,388 (44.0%) received outpatient epinephrine and 1,770 (56.0%) did not.
- Patients who received outpatient epinephrine were older (median age 7.3 vs. 5.0 years; p = 0.01).
- Known food allergy (79.0% vs. 42.8%; p = 0.01) and asthma (18.6% vs. 13.9%; p = 0.01) were more prevalent in those who received epinephrine.
- These patients were less likely to receive outpatient antihistamines (41.6% vs. 45.8%; p = 0.01) but more likely to receive corticosteroids (2.2% vs. 0.9%; p = 0.01)
- ICU admissions were significantly lower in the outpatient epinephrine group (0.7% vs. 1.6%; p = 0.03).
- No significant difference was observed in hospital ward admissions (1.0% vs. 0.6%; p = 0.30).The negative control analysis of outpatient antihistamines did not show a significant impact on hospital outcomes, supporting the specificity of the epinephrine effect.
Conclusion
This study confirms that outpatient epinephrine use significantly reduces ICU admissions in children with anaphylaxis. Despite its well-documented efficacy, under-utilisation of epinephrine remains a concern. These findings highlight the urgent need for enhanced education and training among caregivers and healthcare professionals to ensure the timely administration of epinephrine in anaphylactic emergencies.
Importance of this study for South Africa
Of the 156 episodes analysed, more than 40% were graded as severe, and nearly two-thirds of patients were seen for recurrent episodes. Males, younger children, and individuals of mixed-race ethnicity were more frequently affected.
Ongoing education and training of patients, parents, teachers, and healthcare workers is identified as a key area for intervention, to improve outcomes in these patients.
Additional References
1. Chippendale, S. E., Reichmuth, K., Worm, M., & Levin, M. (2022). Paediatric anaphylaxis in South Africa. The World Allergy Organization journal, 15(9), 100666. https://doi.org/10.1016/j.waojou.2022.100666
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