Two new studies show anaphylaxis treatment remains confusing for patients, caregivers, and emergency personnel.

RT’s Three Key Takeaways:

  1. ​​Widespread Confusion About Anaphylaxis Treatment: Two studies presented at the ACAAI Annual Scientific Meeting reveal that both patients and emergency personnel often misunderstand proper treatment protocols for anaphylaxis.
  2. Barriers to Epinephrine Use: Despite being prescribed epinephrine, many patients face barriers such as uncertainty about symptoms, fear of needles, and reluctance to seek emergency care, contributing to a delay in administering life-saving treatment.
  3. Inconsistent EMS Protocols for Anaphylaxis: An analysis of EMS protocols across the US shows gaps in the recognition and treatment of anaphylaxis, with many states lacking comprehensive guidelines, particularly around gastrointestinal and neurologic symptoms, and some relying on outdated treatments.

Anaphylaxis can come on suddenly and without warning, and because its symptoms can be fatal, it is scary for those who encounter it. 

Two new studies being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Boston show it is not only patients and caregivers who misunderstand how best to treat anaphylaxis but also emergency medical professionals often follow incorrect protocols for treating severe allergic reactions.

“We know early recognition of anaphylaxis and treatment with epinephrine improves outcomes,” says Sasha Alvarado, DO, co-director of quality and safety for the division of immunology, allergy and retrovirology at Baylor College of Medicine, in a release. 

Joni Chow, DO, pediatric resident at Baylor College of Medicine, San Antonio and lead author of the study explains in a release, “We surveyed 96 patients and caregivers in an allergy clinic waiting room to evaluate knowledge of anaphylaxis and desired components of an anaphylaxis action plan. The results demonstrate the need for better education of allergy patients to recognize and treat anaphylaxis appropriately.”

Although 95% of the respondents in the study were prescribed epinephrine and 73% said they were comfortable with recognizing anaphylaxis symptoms, only 14% of respondents said they were very likely to use epinephrine first for anaphylaxis. 

The following were barriers to using epinephrine:

  • Not sure which symptoms to treat (40.6%)
  • Hesitant to go to the emergency room (24%)
  • Hesitant to call 911 (17.7%)
  • Not sure how to use epinephrine auto-injectors (11.5%)
  • Feared needles (5.2%)

Examining Differences in EMS Protocols

A second study examined the differences across emergency medical services (EMS) in the United States regarding protocols used in the prehospital treatment of anaphylaxis. The study performed an analysis of statewide anaphylaxis protocols to identify gaps in the recognition of anaphylaxis and to provide areas for improvement in prehospital management.

“Many EMS anaphylaxis protocols are incomplete and/or outdated,” says Carly Gunderson, DO, lead author of the study, in a release. “The discrepancies include variations in the definition of anaphylaxis as well as in treatment.”

Thirty states, those with a mandatory Advanced Cardiac Life Support protocol were included in the study. Of the 30 states, only 50% (15) included gastrointestinal symptoms in the definition of anaphylaxis, and only 40% (12) included neurologic manifestations. 47% (14) used a two-organ system definition. 

For anaphylactic reactions, 100% (30) of protocols recommended diphenhydramine and epinephrine. 90% (27) recommended albuterol if respiratory symptoms were present, 73% (22) recommended intravenous fluids, and 60% (18) recommended steroids. Epinephrine was the first line recommendation for anaphylaxis in 97% (29) of protocols. 25 states (83%) allowed epinephrine autoinjectors and 17 (57%) provided autoinjectors.

The authors said it was surprising that many EMS protocols did not consider gastrointestinal or neurologic manifestations to be a component of anaphylaxis. Additional outdated recommendations included the use of steroids and first-generation antihistamines. Many protocols did not permit or provide epinephrine autoinjectors, despite their convenience and effectiveness. 

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