The mismanagement of anaphylaxis by both patients and healthcare professionals is significantly attributed to misinformation and outdated protocols, underscored by findings from two recent studies unveiled at the American College of Allergy, Asthma, and Immunology Annual Scientific Meeting.
Anaphylaxis can manifest unexpectedly, and many individuals who are at risk—including patients and their caregivers—lack clear knowledge about which symptoms necessitate treatment with epinephrine, highlighted Joni Chow, DO, from Baylor College of Medicine in San Antonio, Texas, during her presentation at the meeting.
“Early identification of anaphylaxis and prompt administration of epinephrine are vital for enhancing patient outcomes,” Chow emphasized in a subsequent interview.
“Many allergic reactions transpire in community environments, where written action plans are crucial in guiding patients and their caregivers on recognizing and responding to these life-threatening situations,” she elaborated. “Currently, these anaphylaxis action plans are primarily formulated based on the consensus from healthcare professionals, often lacking insights into the preferences and needs of patients and caregivers,” she indicated. Nonetheless, Chow pointed out that despite having action plans, numerous patients and families struggle with recognizing and effectively managing severe allergic reactions.
In an endeavor to tackle this issue, Chow and her team devised a survey aimed at gauging the comprehension of anaphylaxis recognition and management among patients and caregivers, as well as understanding their preferences regarding the components of action plans.
Chow and her team collected data from 96 patients and caregivers in the waiting area of an allergy clinic. Notably, 95% of the participants had been prescribed epinephrine. While 73% expressed confidence in identifying signs of anaphylaxis, merely 14% stated they were likely to use epinephrine as their initial course of treatment.
The predominant reason cited for reluctance to use epinephrine was uncertainty regarding which symptoms to address (40.6%). Other factors included a hesitance to visit an emergency department (24%), a reluctance to call 911 (17.7%), doubt about how to properly use epinephrine auto-injectors (11.5%), and a fear of needles (5.2%).
Furthermore, even though 85% of participants were aware that antihistamines do not negate the necessity for epinephrine during anaphylactic reactions, 23.7% indicated they would resort to antihistamines as their first line of treatment.
Among patients experiencing rash and wheezing following suspected allergen exposure, around two-thirds (64.5%) affirmed that they would administer epinephrine, while 10.8% stated they would head to the emergency room before taking any initial action, according to Chow’s presentation.
Interestingly, the anticipated impact of fear of needles was lower than expected, as it is traditionally viewed as a significant barrier to the utilization of epinephrine. “However, our respondents were more inclined to indicate that their reluctance to escalate to emergency responses was the primary obstacle to treatment,” Chow conveyed.
The survey also explored which features of an anaphylaxis action plan would be most beneficial for patients. A substantial majority (93%) deemed a section addressing the management of mild (non-anaphylactic) allergic symptoms as somewhat or very important. Visual aids for administering epinephrine and illustrations depicting symptoms of anaphylaxis were also viewed as somewhat or very important by 87.6% and 81% of respondents, respectively.
This study accentuates the necessity of educating allergy patients on recognizing and treating anaphylaxis, highlighting that the surveyed population showed a preference for visual aids in their action plans. “While many patients and caregivers believe they know how to manage anaphylaxis, a significant number would not opt for epinephrine as their first treatment choice,” Chow noted.
“The study concentrated on a singular community clinic, thus gathering feedback from a broader array of patients and caregivers with diverse educational, cultural, social, and economic backgrounds would be advantageous,” Chow emphasized. “Moreover, gaining insights from other stakeholders, such as school nurses, would further enrich our understanding,” she added.
Clinical Anaphylaxis Protocols Fall Short
The second study showcased at the meeting highlighted the urgent need to enhance anaphylaxis education among clinicians.
Carly Gunderson, DO, from Memorial Healthcare System in Pembroke Pines, Florida, noted that discrepancies in anaphylaxis management stem from variations in how the condition is defined and treated.
“Frequently, we encounter patients whose symptoms meet anaphylaxis criteria, yet when they call 911, the arriving emergency medical services (EMS) often do not administer epinephrine,” Gunderson shared in an interview. “Instead, they receive antihistamines and steroids, but not epinephrine, which is deeply troubling since epinephrine is universally recognized as the first-line treatment for anaphylaxis,” she stated.
“As EMS personnel are typically the first healthcare providers to evaluate patients experiencing anaphylaxis, their proficiency in recognizing and treating the condition is paramount,” Gunderson asserted.
Gunderson and her colleagues examined data across 30 states with mandatory Advanced Cardiac Life Support protocols to pinpoint gaps in anaphylaxis recognition and prehospital management enhancements.
Shockingly, only half of the states (15 states) incorporated gastrointestinal symptoms into their definitions of anaphylaxis, 40% recognized neurologic symptoms, and 47% adopted a definition based on a two-organ system, as noted by Gunderson in her presentation.
Remarkably, although all 30 state protocols endorsed the use of diphenhydramine and epinephrine for anaphylactic reactions, only 25 states allowed the usage of epinephrine autoinjectors, and just 17 states provided actual autoinjectors.
“It was alarming to discover the number of protocols that failed to include common gastrointestinal (like abdominal pain and vomiting) as well as neurologic (such as lethargy and altered mental state) symptoms,” Gunderson told Medscape Medical News.
“We were equally disappointed to find that many protocols still endorse outdated treatments like first-generation antihistamines and corticosteroids for addressing anaphylaxis,” she elaborated.
While it is evident that anaphylaxis management has progressed, Gunderson’s study indicates a clear need for improvement in educating healthcare providers on the identification and timely treatment of the condition. “Many associate anaphylaxis solely with symptoms such as facial swelling and throat constriction, yet it presents in numerous other ways,” she explained. “Healthcare professionals must be educated on recognizing these varied manifestations to ensure timely treatment and enhance patient outcomes,” she asserted.
Finally, Gunderson acknowledged that the study’s limitations were due to its focus exclusively on states with mandatory or model EMS protocols. She emphasized that a crucial next step in research involves identifying practical methods to implement necessary changes to existing protocols.
Real-World Data Support Need for Education
S. Shahzad Mustafa, MD, leading physician in allergy, immunology, and rheumatology at Rochester Regional Health, remarked on the significance of real-world studies for pinpointing current practices and improvement opportunities for anaphylaxis management. “The ongoing evolution in anaphylaxis management underscores the necessity for studies like these to streamline evidence-based treatment across various medical settings, including emergency medical services, urgent care facilities, and emergency departments,” Mustafa, who was not involved in either study, stated in an interview.
Mustafa noted that the findings of both studies were anticipated and echoed a larger recognition of variability in medical care across numerous conditions, including anaphylaxis. “Both patients and healthcare providers continue to express hesitation regarding the utilization of epinephrine and tend to over-rely on antihistamines or systemic steroids,” he acknowledged.
For both studies, the overarching message is clear: education is crucial for optimizing anaphylaxis management, according to Mustafa. “Education must emphasize the timely recognition of anaphylaxis, including non-typical symptoms such as gastrointestinal manifestations, along with the appropriate use of epinephrine,” he advised.
Looking forward, there is a need for research elucidating differential clinical outcomes based on varied approaches to anaphylaxis. This may underscore the importance of early recognition and prompt treatment with epinephrine,” Mustafa suggested, emphasizing that anaphylaxis management is a viable candidate for quality improvement initiatives.
Heidi Splete is a Bethesda, Maryland-based freelance medical writer.
The Anaphylaxis Antics: Misinformation, Mishaps, and a Dash of Epinephrine
Oh, gather ’round, dear friends! It seems we’re back in the delightful world of *anaphylaxis*—where confusion reigns supreme and misinformation waltzes merrily hand-in-hand with outdated protocols. Just when you thought your allergic reactions couldn’t get any more thrilling, two studies have just crashed the party, presenting their kooky findings at the American College of Allergy, Asthma and Immunology Annual Scientific Meeting. Spoiler alert: it’s the sort of stuff that’ll make you want to sprinkle some epinephrine on your toast each morning!
Recognizing the Ruckus: How Many Symptom Signs Does it Take?
Dr. Joni Chow, who, I must say, deserves a medal for bravery (or at least a cup of strong coffee), disclosed that many patients and caregivers at risk of anaphylaxis are baffled when faced with the prospect of using their beloved epinephrine. You know, the sort of reaction that’s so sudden even your breakfast won’t prepare you. With 73% feeling confident they could spot symptoms but only 14% ready to give epinephrine a whirl, it’s clear something is amiss. It’s almost like asking a cat to do the cha-cha; they might look the part, but don’t expect them to actually participate!
Why the Reluctance?
Among the excuses for avoiding the life-saving stab of epinephrine, uncertainty about symptoms was the biggest culprit—40.6% of respondents claimed they didn’t know which symptoms to treat! You can almost hear the collective sigh of doctors everywhere, can’t you? “Ah, yes, let’s just have a cup of chamomile instead of an adrenaline shot,” they’d mutter under their breath. The fear of needles was surprisingly low on the list, showing that what really drives people away from the action is the fear of an emergency room visit. Goodness, isn’t that just adding a dose of drama to an already precarious situation?
Action Plans? More Like Reaction Plans!
The irony here is thick enough to cut with a butter knife! Although a whopping 95% of survey respondents were prescribed epinephrine, many knew how to treat allergic reactions but were still unsure about using it as their first course of action. And here you thought *adulting* was hard! The study highlights a significant void in the communication between healthcare professionals and patients. It’s almost as if these action plans were written in a secret code only decipherable by PhD-holding aliens. Maybe some visual aids would help, like a cartoon depicting when *not* to be a hero and when to jab that needle into your thigh!
Healthcare’s Hiccups: The Emergency Medical Services Edition
Hold onto your hats, folks! Dr. Carly Gunderson confronted another scandalous tidbit: healthcare professionals often aren’t up to speed on recognizing and treating anaphylaxis. Goodness gracious! Apparently, only 15 out of 30 states included gastrointestinal symptoms in their anaphylaxis definitions. How can you miss that when it’s literally a gut-wrenching emergency? It’s as if they’re treating it like an inconvenient sneeze! Would you attend a wedding and skip the vows? Of course not! And yet, our response to potential anaphylaxis seems to be missing the whole shebang!
A Sea of Confusion
Dr. Gunderson lamented the outdated recommendations for treating anaphylaxis—first-generation antihistamines are still lurking in protocols like that one friend who refuses to leave the party. Seriously! Are we expected to believe that these once-standard treatments will still save the day against the superhero that is anaphylaxis? The medical world is evolving, but some of these practices belong in a museum next to dinosaurs and rotary phones!
Real-World Revelations: The Lessons to Take Home
Dr. S. Shahzad Mustafa articulated the essence of the matter beautifully: education is key! Patients and healthcare providers alike must focus on timely identification and appropriate treatment—no more relying on potions and fairy dust (read: antihistamines and steroids) in place of proper care! There’s a call for sweeping changes based on real-world data, and it’s louder than a toddler having a tantrum in the candy aisle. What louder alarm can we sound to ensure that everyone knows: “Epinephrine is your best pal in anaphylaxis!”
Final Thoughts
So, here we stand, at the brink of epinephrine revolution, armed with knowledge and perhaps just a pinch of enthusiasm! The findings from these studies demonstrate a crucial need for better education regarding anaphylaxis management—from clinics to kitchens; from schools to the emergency room. Let’s keep the misinformation in the past and ensure that every allergic reaction is armed and ready to fight (with epinephrine, of course). Who knew that the path to success in anaphylaxis management would take a dose of humor, a sprinkle of sharp wit, and, naturally, that lifesaving injection? Cheers to a world where confusion takes a backseat, and education rides shotgun!
S that even when patients meet anaphylaxis criteria, EMS often opts for antihistamines instead of the urgently needed epinephrine. “When an emergency occurs, we can’t afford to play doctor with outdated remedies,” she insists. With such a critical gap in education and response, many are left floundering in the ocean of confusion surrounding anaphylaxis.
**Interview with Dr. Joni Chow**
**Interviewer:** Thank you for joining us today, Dr. Chow. Your presentations at the American College of Allergy, Asthma, and Immunology Annual Scientific Meeting shed light on a significant issue in anaphylaxis management. Can you start by explaining why it’s so crucial for patients and caregivers to recognize anaphylaxis symptoms early?
**Dr. Joni Chow:** Absolutely! Early identification and prompt administration of epinephrine are vital for enhancing patient outcomes. Anaphylaxis can escalate quickly, and if patients hesitate or misinterpret symptoms, it can lead to severe consequences. The goal is to empower patients and caregivers with the knowledge they need to act swiftly.
**Interviewer:** Your survey results are quite revealing. Despite 95% of participants being prescribed epinephrine, only 14% said they’d use it first in an emergency. What do you think is driving that reluctance?
**Dr. Chow:** The primary reason cited was uncertainty regarding which symptoms necessitate treatment with epinephrine—about 40.6% of respondents specified this. It seems that even with action plans, there’s a disconnect between understanding the symptoms and feeling equipped to respond appropriately.
**Interviewer:** You mentioned the idea of incorporating visual aids into action plans. How do you think this could potentially change patient responses during anaphylaxis?
**Dr. Chow:** Visual aids can significantly enhance understanding! Educational materials that include illustrations of symptoms and clear instructions on administering epinephrine could bridge the gap between knowledge and action. Our survey indicated that many patients preferred these aids, suggesting they could help clarify any uncertainties.
**Interviewer:** You also pointed out that many community plans are driven primarily by healthcare professionals. Do you think involving patients and caregivers in the creation of these plans could lead to better outcomes?
**Dr. Chow:** Definitely. Action plans should cater to the needs and experiences of patients and caregivers. Involving them in the design could ensure these plans are practical and relatable, ultimately helping them manage any allergic reactions with more confidence.
**Interviewer:** Lastly, what do you believe is the takeaway message for both healthcare providers and patients regarding anaphylaxis management?
**Dr. Chow:** Education is key. For healthcare professionals, it’s critical to stay updated on the symptoms and appropriate treatments for anaphylaxis. For patients, understanding their condition and being proactive about their treatment options can save lives. We need to work together to eliminate misinformation and ensure everyone is prepared when it matters most.
**Interviewer:** Thank you, Dr. Chow, for your insights and for emphasizing the importance of education in combatting anaphylaxis.
**Dr. Chow:** Thank you for having me! Let’s continue to spread awareness and improve patient outcomes.
Increase confidence and clarity during critical moments.
**Interviewer:** In your findings, how do you think the communication between healthcare professionals and patients could be improved regarding anaphylaxis management?
**Dr. Chow:** It’s essential to refine how healthcare providers communicate action plans. They shouldn’t just be standard protocols; instead, they should incorporate patients’ experiences and preferences. Engaging patients in the planning process might foster a greater sense of ownership and understanding about when and how to use epinephrine.
**Interviewer:** Moving on to the second study presented at the meeting, Dr. Carly Gunderson highlighted discrepancies in how anaphylaxis is managed by emergency medical services (EMS). What are your thoughts on that?
**Dr. Chow:** That is a concerning issue. If EMS personnel do not fully recognize the symptoms of anaphylaxis or use outdated protocols, patients could be placed at risk. There needs to be a concerted effort to ensure that all first responders are educated on the latest anaphylaxis guidelines so that they can efficiently administer epinephrine when necessary.
**Interviewer:** Lastly, what is your message to patients and caregivers about anaphylaxis?
**Dr. Chow:** Don’t underestimate the importance of education! Being informed about your allergies, recognizing symptoms, and understanding the life-saving role of epinephrine can change outcomes drastically. Empower yourself with knowledge, encouraging open communication with healthcare providers to ensure you’re well-prepared for emergencies.
**Interviewer:** Thank you for your insights today, Dr. Chow. Your work is critical in raising awareness about this life-threatening condition.
**Dr. Chow:** Thank you for having me! Together, we can help demystify anaphylaxis and foster a safer environment for those at risk.
