A new study shows emergency departments often do not follow recommended treatment guidelines for severe allergic reactions to insect stings. These findings are featured in the September 2005 Journal of Allergy & Clinical Immunology (JACI). The JACI is the peer-reviewed, scientific journal of the American Academy of Allergy, Asthma & immunology (AAAAI).
In a review of 15 North American emergency departments, Sunday Clark, ScD, from the Department of Emergency Medicine at Massachusetts General Hospital and colleagues evaluated the medical records of 617 patients with insect sting allergies.
Among the patients, researchers found that 58% had local reactions, 11% had mild systemic reactions, and 31% experienced a sudden, severe allergic reaction called anaphylaxis. Anaphylaxis is a potentially life-threatening allergic reaction with symptoms ranging from itching and hives over large areas of the body, swelling in the throat or tongue to a rapid fall in blood pressure that can result in loss of consciousness and death.
The study found:
While in the ED, only 12% of the patients with mild or severe allergic reactions received epinephrine, the recommended treatment for severe reactions to insect stings. 69% of the patients received antihistamines, while 50% received systemic corticosteroids.
Only 31% of the patients with mild or severe allergic reactions received a prescription for self-injectable epinephrine when leaving the ED.
Only 21% of the patients were referred to an allergist/immunologist for further evaluation and management of insect sting allergies.
“Because the ED is the most common medical setting for diagnosing and treating anaphylaxis, advances in anaphylaxis management will need the active participation of emergency medicine clinicians and researchers,” said Carlos Camargo, MD, FAAAAI, emergency physician at Massachusetts General Hospital and coauthor of the study.
Current guidelines for treating patients with severe allergic reactions to insect stings recommend epinephrine as the gold standard for treatment, and teaching the proper techniques for self-administration of epinephrine the next time the patient is stung. Guidelines also recommend that patients be referred to an allergist/immunologist for further management of their allergies. However, this study demonstrates that compliance with recommended treatment guidelines is low, even among those patients who come into the ED with severe reactions.
“This study demonstrates an opportunity for ED staff to guide patients with potentially life-threatening allergies toward better allergy management,” Camargo said.