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Clark E, Kase Tanno L, Vo T, Blanc B, Demoly P, Caimmi D. Anaphylaxis management in a French pediatric emergency department: Lessons from the ANA-PED study. Clin Transl Allergy 2023; 13:e12289. [PMID: 37632240 PMCID: PMC10392053 DOI: 10.1002/clt2.12289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Anaphylaxis is a serious systemic hypersensitivity reaction that requires immediate recognition and prompt administration of epinephrine/adrenaline. The present study aimed to assess the appropriateness of epinephrine/adrenaline use in children identified as allergic by physicians in the emergency department (ED) at the time of the reaction, and to identify factors that are possibly associated with epinephrine/adrenaline administration, auto-injector prescription, and further referral to an allergist. METHODS We performed a retrospective cross-sectional study at the pediatric ED of the University Hospital of Montpellier, France. We included all consecutive children who attended the ED between 2016 and 2020 with an allergy-related diagnosis at discharge. RESULTS We included 1056 allergy-related visits, including 224 (21.2%) with a diagnosis of anaphylaxis at discharge; only 17.0% of them received an epinephrine/adrenaline injection, and 57.1% consulted an allergist after the acute episode. An auto-injector was prescribed to 63 (28.1%) patients at discharge from the ED. Besides the severity of the clinical presentation, factors associated with a guidelines-based management of the anaphylactic reaction and with an increased administration rate of epinephrine/adrenaline included presence of asthma symptoms and presence of extended skin reactions. CONCLUSIONS Our study underlines persistent gaps in the management of pediatric anaphylaxis in ED, focusing on hereby identified levers. By disseminating current knowledge and guidelines on anaphylaxis and allergies, specialists could work together with emergency physicians to establish effective management algorithms and improve anaphylaxis management and care pathways for children experiencing allergic reactions, especially anaphylaxis. TRAIL REGISTRATION Clinical Trials, number NCT05112367.
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Affiliation(s)
- Evangéline Clark
- Allergy Unit of the PneumologyAllergy and Thoracic Oncology ServiceUniversity Hospital of MontpellierMontpellierFrance
- IDESPUMR UA11INSERMUniversity of MontpellierMontpellierFrance
| | - Luciana Kase Tanno
- Allergy Unit of the PneumologyAllergy and Thoracic Oncology ServiceUniversity Hospital of MontpellierMontpellierFrance
- IDESPUMR UA11INSERMUniversity of MontpellierMontpellierFrance
| | - Tram Vo
- IHU Méditerranée InfectionAP‐HMMEPHIMarseilleFrance
| | - Brigitte Blanc
- Pediatric Emergency DepartmentUniversity Hospital of MontpellierMontpellierFrance
| | - Pascal Demoly
- Allergy Unit of the PneumologyAllergy and Thoracic Oncology ServiceUniversity Hospital of MontpellierMontpellierFrance
- IDESPUMR UA11INSERMUniversity of MontpellierMontpellierFrance
| | - Davide Caimmi
- Allergy Unit of the PneumologyAllergy and Thoracic Oncology ServiceUniversity Hospital of MontpellierMontpellierFrance
- IDESPUMR UA11INSERMUniversity of MontpellierMontpellierFrance
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Gil-Jardine C, Lefort H, Gil C, Ramage C, Bounaud N, Chauvin A. [A trilogy to understand: adrenalin, allergy and anaphylaxis]. REVUE DE L'INFIRMIERE 2022; 71:24-26. [PMID: 36150834 DOI: 10.1016/j.revinf.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Allergy, anaphylaxis and adrenaline are three closely related terms in medicine. Upon identification or suspicion of anaphylaxis, adrenaline should be administered as soon as possible. An allergy can be characterised by anything from a simple skin rash to severe vital parameter abnormalities. The role of the reception nurse will be first to identify clinically relevant features, to assign the right level of triage to the patient and adjust the care pathway.
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Affiliation(s)
- Cédric Gil-Jardine
- Structure des urgences, CHU Pellegrin, rue de la Pelouse de Douet, 33000 Bordeaux, France; INSERM, ISPED, Bordeaux Population Health research center INSERM U1219 - AHEAD team, F-33076 Bordeaux Cedex, France, E.U..
| | - Hugues Lefort
- Structure des urgences, Hôpital d'instruction des armées Laveran, 13384 Marseille, France
| | - Coralie Gil
- Structure des urgences, CHU Pellegrin, rue de la Pelouse de Douet, 33000 Bordeaux, France
| | - Cécile Ramage
- Structure des urgences, CHU Pellegrin, rue de la Pelouse de Douet, 33000 Bordeaux, France
| | - Nicolas Bounaud
- Structure des urgences, CH Montauban, 100 rue Léon-Cladel, 82000 Montauban, France
| | - Anthony Chauvin
- Structure des urgences, CHU Lariboisière, 2 rue Ambroise-Paré, 75010 Paris, France
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3
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Chevillard C, Quercy L, Aubertin O, Rousseau G, Bounaud N. [Allergy risk assessment and surveillance]. REVUE DE L'INFIRMIERE 2022; 71:18-20. [PMID: 36150832 DOI: 10.1016/j.revinf.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The assessment of a patient's allergic risk can be based on the ABCDE methodology to be standardized. Hospital monitoring should be routine in case of signs of anaphylaxis.
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Affiliation(s)
| | - Laetitia Quercy
- Urgences-Samu-Smur, CH Montauban, 100 rue Léon-Cladel, 82000 Montauban, France
| | - Olivier Aubertin
- Urgences-Samu-Smur, CH Montauban, 100 rue Léon-Cladel, 82000 Montauban, France
| | - Geoffroy Rousseau
- Département de médecine d'urgence, CHRU Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - Nicolas Bounaud
- Urgences-Samu-Smur, CH Montauban, 100 rue Léon-Cladel, 82000 Montauban, France.
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Eyer X, Fauconnier S, Villois S, Attali C, Chauvin A. [Care in the first hours]. REVUE DE L'INFIRMIERE 2022; 71:21-23. [PMID: 36150833 DOI: 10.1016/j.revinf.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Isolated mucocutaneous involvement and anaphylaxis are two frequent pathologies in the emergency room. Recognition of the symptoms and the rapidity of treatment are essential for the clinical evolution. Monitoring and standardisation of patient discharge from the emergency department is a guarantee of quality and reduces the risk of morbidity and mortality.
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Affiliation(s)
- Xavier Eyer
- Structure des urgences, CHU Lariboisière, AP-HP, 2 rue Ambroise-Paré, 75010 Paris, France.
| | - Sandrine Fauconnier
- Structure des urgences, CHU Lariboisière, AP-HP, 2 rue Ambroise-Paré, 75010 Paris, France
| | - Sophie Villois
- Structure des urgences, CHU Lariboisière, AP-HP, 2 rue Ambroise-Paré, 75010 Paris, France
| | - Charlotte Attali
- Structure des urgences, CHU Lariboisière, AP-HP, 2 rue Ambroise-Paré, 75010 Paris, France
| | - Anthony Chauvin
- Structure des urgences, CHU Lariboisière, AP-HP, 2 rue Ambroise-Paré, 75010 Paris, France
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Pouessel G, Antoine M, Pierache A, Dubos F, Lejeune S, Deschildre A. Factors associated with the underuse of adrenaline in children with anaphylaxis. Clin Exp Allergy 2021; 51:726-729. [PMID: 33400309 DOI: 10.1111/cea.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Guillaume Pouessel
- Department of Pediatrics, Children's Hospital, Roubaix, France.,Pediatric Pulmonology and Allergy Department, CHU Lille, Hôpital Jeanne de Flandre, Lille, France
| | | | - Adeline Pierache
- EA 2694-Santé Publique: Epidemiology and Healthcare Quality, CHU Lille, Lille University, Lille, France
| | - François Dubos
- Pediatric Emergency Unit and Infectious Diseases, Lille, France
| | - Stéphanie Lejeune
- Pediatric Pulmonology and Allergy Department, CHU Lille, Hôpital Jeanne de Flandre, Lille, France
| | - Antoine Deschildre
- Pediatric Pulmonology and Allergy Department, CHU Lille, Hôpital Jeanne de Flandre, Lille, France
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Roberts G, Almqvist C, Boyle R, Crane J, Hogan SP, Marsland B, Saglani S, Woodfolk JA. Developments allergy in 2019 through the eyes of Clinical and Experimental Allergy, Part II clinical allergy. Clin Exp Allergy 2020; 50:1302-1312. [PMID: 33283366 DOI: 10.1111/cea.13778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the second of two linked articles, we describe the development in clinical as described by Clinical & Experimental Allergy and other journals in 2019. Epidemiology, clinical allergy, asthma and rhinitis are all covered. In this article, we described the development in the field of allergy as described by Clinical and Experimental Allergy in 2019. Epidemiology, clinical allergy, asthma and rhinitis are all covered.
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Affiliation(s)
- Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - R Boyle
- Department of Paediatrics, Imperial College London, London, UK
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Department of Pathology, Michigan Medicine, Mary H Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI, USA
| | - B Marsland
- Department of Immunology and Pathology, Monash University, Melbourne, Vic, Australia
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - J A Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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A Proposal from the Montpellier World Health Organization Collaborating Centre for Better Management and Prevention of Anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:676-683.e1. [PMID: 33059097 DOI: 10.1016/j.jaip.2020.09.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/23/2022]
Abstract
Since the first description of anaphylaxis in 1902, its clinical importance as an emergency condition has been recognized worldwide. Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction characterized by rapid onset and the potential to endanger life through respiratory or circulatory compromise. It is usually, although not always, associated with skin and mucosal changes. Although the academic/scientific communities have advocated to promote greater awareness and protocols for the management of anaphylaxis based on best evidence, there are few efforts documenting feedback as to the success of these efforts. In this article, we review the key unmet needs related to the diagnosis and management of anaphylaxis, and propose a public health initiative for prevention measures and a timetable action plan that intends to strengthen the collaboration among health professionals and especially primary care physicians dealing with anaphylaxis, which can encourage enhanced quality of care of patients with anaphylaxis. More than calling for a harmonized action for the best management of anaphylaxis to prevent undue morbidity and mortality, the Montpellier World Health Organization Collaborating Centre here proposes an action plan as a baseline for a global initiative against anaphylaxis. We strongly believe that these collaborative efforts are a strong public health and societal priority that is consistent with the overarching goals of providing optimal care of allergic patients and best practices of allergology.
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