When Is Epinephrine Used in Anaphylaxis?

Epinephrine is the drug of choice for anaphylaxis, however it is widely underused. An observational study of all anaphylaxis at the general and pediatric Emergency Department (ED) was led in a third-level hospital in Madrid. Adults were included May 2009-2010 and children March 2012-2014. Multivariate analysis was used to find factors that induced the use of epinephrine. At the EDs, 259 patients were attended. Adults (n=116): 49.1% female, mean age 44.4±17.4 years, 19.8% atopic (25% severe anaphylaxis). Only 44% were diagnosed with anaphylaxis at the ED. 39.7% received epinephrine. Children (up to 15 y/o, n=133): 56,69% female, mean age 5.5±4.3 years, 69.2% atopic (14.3% severe anaphylaxis). 52.6% diagnosed of anaphylaxis at the ED. Epinephrine was administered to 43.6%. Epinephrine use was not related to severity of anaphylaxis, age, gender or atopy. It was only related to having been diagnosed with anaphylaxis at the EDs (OR 33.1; 95%CI 15.5-71). At the Allergy Department, 176 patients were subsequently attended (51.7% adults, 88.7% children). Adults 41.7% drugs, 25% food; children 89.8% food. Epinephrine autoinjector (EAI) was prescribed to 28.3% adults, 55.1% children (p=0.001). Prescription of EAI increased in food allergy (OR 15.2; 95%CI 2.5-91.1). It was unrelated to severity of anaphylaxis, management at the EDs, age, gender or atopy. A correct diagnosis of anaphylaxis at the EDs is determinant for the epinephrine use. The use of epinephrine is not related to the severity of the anaphylaxis at the EDs. EAI is more prescribed to children, probably due to the more common food allergies.