WP 4.1 - A new treatment paradigm for anaphylaxis – emphasis on Early Treatment with Adrenaline (ETA)

Background:

The only evidence-based first line treatment of anaphylaxis is administration of adrenaline.  Unfortunately, prompt administration is often delayed or even omitted both by the patient (self-injection) and in the Emergency Room (ER), thereby significantly increasing the risk of fatal outcome. Adjuvant treatment with sedating antihistamines and glucocorticoids is neither evidence-based nor efficient, but is often administered to patients on a routinely basis instead of adrenaline.

 

Hypothesis:

Despite written treatment plans for the patient and in the Emergency Room, administration of Adrenaline is often omitted or delayed. The hypothesis are that:

  • the patient, despite specific training fail to recognize the severity of the reaction and
  • the standard treatment in the ER with antihistamines disguise the upper respiratory and cutaneous signs and thereby delay effective treatment.

A new treatment paradigm with early treatment with adrenaline will improve safety for the patient. Concomitantly, treatment with antihistamines will be changed to use of non-sedating antihistamines where applicable.

 

Methods:

Data on frequency, severity and treatment (adrenaline, antihistamine, glucocorticoids, other medications, oxygen, duration of admission in ER/ward) of anaphylactic reactions in children and adults obtained from WP 1.1 and WP 1.2 will be analyzed with special focus on when and why (not) adrenaline was administered by the patient, caretaker or pre-hospital/ hospital emergency staff.

Hereafter, a new treatment paradigm (according to guidelines developed by European Academy of Allergology and Clinical Immunology) will be launched. Standard Operating Procedures both for patient self care, pre-hospital and in the hospital (ER and departments) will focus on the need for adrenaline in the patient omitting routine first line administration of antihistamines and glucocorticoids. These will be used pro re nata like other treatments such as beta2-agonists in the case of asthma.

 

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