• Only 8% of patients diagnosed with drug-induced anaphylaxis in the ED were given epinephrine and only 18% of this population were evaluated by an allergist/immunologist in the 1 year following their reaction.31

• Implementation of an anaphylaxis order set increased the rate of epinephrine administration in the ED by ~20%.45

• The NIAID 2006 guidelines for the treatment of anaphylaxis have improved the treatment of management of anaphylaxis with one pediatric ED showing a significant increase in the rate of epinephrine use via the IM route from 6% to 46%. However, only 61% of patients received EAIs upon discharge with no significant change with implementation of the guidelines. There was a significant increase in allergy referrals; however, still, only 48% of patients received referrals post guideline.28

• In adult patients seen in the ED, drugs are the most common cause of anaphylaxis and several studies demonstrate that less than half of patients diagnosed with anaphylaxis receive epinephrine.29

• A retrospective chart review of pediatric patients diagnosed with anaphylaxis in the ED showed that only 56% of patients received IM epinephrine and 63% of these patients received a prescription for an EAI. Referral to an allergist was made in only 33% of cases.33

• While physicians might assume that epinephrine injection is a cause for increased patient stress, a recent study demonstrated that in patients experiencing anaphylaxis, epinephrine use was actually associated with an increased quality of life.40

• While there is no one specific diagnostic test to identify anaphylaxis, The NIAID/FAAN criteria were validated in the ED to have a sensitivity of 96.7% and a specificity of 82.4%.32

• Only 38% of patients suspected of having anaphylaxis in the ED had documented follow-up by an allergist, and 35% of these patients had an alteration in the diagnosis and/or trigger of anaphylaxis.49