Izvorni znanstveni članak
Is adrenaline misused in anaphylaxis treatment? Experience of a large, urban Emergency Department: review of 589 cases.
Gianfranco Cervellin
; Emergency Department Academic Hospital of Parma 43126 Parma, Italy
Giuseppe Lippi
; Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy
Erminia Ridolo
; Department of Clinical and Experimental Medicine, Postgraduate School of Emergency Medicine, University of Parma, Parma, Italy
Tiziana Meschi
; Department of Clinical and Experimental Medicine, Postgraduate School of Emergency Medicine, University of Parma, Parma, Italy
Fabio Schirosa
; Emergency Department, Academic Hospital of Parma, Parma, Italy
Sažetak
Objective. Acute allergic reactions are important causes of Emergency Department (ED) admissions. Although the current recommendations for treatment of patients with anaphylaxis are focused on the central role of adrenaline, evidence in support of this therapy is still scarce. We planned a retrospective analysis of all allergic and anaphylactic reactions managed in the ED, to assess adherence to current guidelines and clinical outcomes.
Methods. The study population consisted of all consecutive adult patients admitted to the ED with acute allergic reactions during the year 2013. Overall, the final study population consisted of 589 patients, i.e., 329 women and 260 men (55.9% vs. 44.1%, mean age 43±18 years, range 16-96 years).
Results. Fifty-six patients were diagnosed with anaphylaxis (9.5%), 75 with angioedema (12.7%), 363 with urticaria (61.7%), and 95 with urticaria-angioedema (16.1%). The triggers included drugs (21.9%), foods (15.0%), hymenoptera stings (9.9%), and chemicals (4.4%), whereas a specific cause could not be recognized in nearly half of the cases. Only 5 (8.9%) of 56 patients diagnosed with anaphylaxis received adrenaline and no death or Intensive Care Unit (ICU) admission occurred within one month from the acute allergic episode.
Conclusion. The results of our study suggest that anaphylaxis is widely undertreated with adrenaline in our local ED compared to guidelines and recommendations. Nevertheless, a favorable outcome was recorded for all patients included in the study, even when managed with second- and third-line treatments, as attested by the lack of deaths at 1 month and the very limited number of hospitalizations (3/589; 0.5%), related to comorbidities rather than to treatment failure. The strength of recommendations contained in current guidelines should hence be reconsidered.
Ključne riječi
allergy; anaphylaxis; urticaria; angioedema; adrenaline; epinephrine
Hrčak ID:
170157
URI
Datum izdavanja:
1.5.2016.
Posjeta: 949 *