A recent study published in the Journal of Allergy and Clinical Immunology: In Practice found that children suffering anaphylaxis who received epinephrine before going to the emergency department were much less likely to be admitted to the Intensive Care Unit (ICU).
The findings codify what we knew already: prompt administration of epinephrine during anaphylaxis leads to better outcomes.
In an interview with Healio, Roy Kalief, a fourth-year medical student with the Faculty of Medicine and Health Sciences at McGill University and a lead in the study, said:
This study was prompted by the observed inconsistency in the use of pre-hospital epinephrine for anaphylaxis and its unclear impact on hospital outcomes.
By using propensity score matching, the study aimed to isolate the true effect of pre-hospital epinephrine on hospital outcomes, particularly ICU admissions, and address potential confounding variables
The study examined the records of 3,158 children who arrived at the Montreal Children’s Hospital ED with anaphylaxis between April 2011 and November 2023.
The group included 1,388 patients who received outpatient epinephrine (44%) with a median age of 7.3 years, and 1,770 patients who did not (56%) with a median age of 5 years. 79% of those who received outpatient epinephrine and 42.8% of those who did not had a known food allergy.
Rates of ICU admission comprised 1.6% of those who did not receive outpatient epinephrine and 0.7% of those who did.
“This is significant as it underscores the protective role of timely epinephrine administration in preventing severe outcomes,” Khalaf said.
The researchers did not find a significant difference in admission to hospital wards between the groups.
Looking at the data from 1,388 patients who received outpatient antihistamines and 1,388 who did not, the researchers found no significant differences in hospital or ICU admissions between the groups.
Said Khalaf:
These findings are significant because they confirm, using a robust statistical approach, that pre-hospital epinephrine improves critical outcomes even after accounting for confounding factors.
Furthermore, it highlights that the timely administration of epinephrine may have a more pronounced impact on ICU admissions, providing compelling evidence to support its use.
Khalaf said physicians play a significant role toward increasing the use of outpatient epinephrine by ensuring patients at risk for anaphylaxis have access to epinephrine auto-injectors and are properly instructed in their use.
Said Khalaf:
Additionally, during follow-up visits, it is important to educate patients on the importance of using epinephrine early and discuss barriers that might prevent its use, such as fear or misconceptions.
We at SnackSafely.com urge our readers that have been prescribed epinephrine to always take two emergency devices along everywhere, every time, and to administer the first at the first sign of anaphylaxis.
Although not scientific, the majority of the deaths resulting from anaphylaxis we have reported on over the years were due to epinephrine not being available or administered too late after the onset of anaphylaxis.
