Scripties UMCG - Rijksuniversiteit Groningen
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Underdiagnosis and undertreatment of anaphylactic patients at the emergency department

(2017) Oldenburger, T.R.G. (Thomas)

Introduction Anaphylaxis is a serious, allergic reaction that is rapid in onset and may
cause death. Rapid administration of adrenalin can be life saving for anaphylactic
patients. Adrenalin is the treatment of choice for respiratory and cardiovascular
symptoms, and it has a role in the prevention of degranulation of mast cells. Multiple
studies have reported underdiagnosis and undertreatment for anaphylactic patients. In
2005 experts from different allergy organisations proposed diagnostic criteria of
anaphylaxis: the National Institute of Allergy and Infectious disease, and Food
Allergy and Anaphylaxis Network criteria (NIAID/FAAN criteria). These criteria
have been found valuable for clinical practise.
Aims To retrospectively analyse the diagnosis and treatment of anaphylactic patients
with the use of the NIAID/FAAN criteria at the emergency department (ED) of two
teaching hospitals in Amsterdam, the Netherlands.
Methods All patients that visited the ED of the OLVG oost and OLVG west between
01-01-2015 and 31-12-2016 with any form of an allergic reaction were included in
this study. The included patients were retrospectively analysed and it was checked if
they fulfilled the NIAID/FAAN. The diagnosis given by the treating physician was
compared with the outcome of the criteria. Furthermore the treatment of the
anaphylactic patients was checked by the administration of adrenalin, the admission
to a hospital inpatient department and the (observation) time these patients spent at
the ED.
Result In total 548 patients were included in this study. 246 (44.9%) of the 548
patients met the NIAID/FAAN criteria. 141 (57.3%) of these anaphylactic patients
were given a diagnosis by the treating physician at the ED suggesting a milder
allergic reaction. 90 (36.6%) anaphylactic patients did not receive adrenalin as a
treatment. 33 (13.5%) anaphylactic patients were admitted to a hospital inpatient
department. The median time the not-admitted anaphylactic patients spent at the ED
was 2:52 hour.
Conclusion This study demonstrates that 57.3% of anaphylactic patients were
underdiagnosed and 36.6% of the anaphylactic patients were undertreated at the ED.
The results indicate the diagnosis and treatment of anaphylactic patients must be
improved, especially since adrenalin administration can be life saving.

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