Treatment and Outcome of Anaphylactic Reactions in Emergency Medical Services of Dresden/Germany: A 5-Year Analysis.

Abstract

Introduction: Anaphylactic reactions can lead to life-threatening situations. Therefore, a rapid diagnosis and therapy are indicated. Various guidelines recommend immediate treatment with intramuscular adrenaline in severe anaphylaxis. Based on study data from different countries, it has been shown that therapy of anaphylaxis is often not carried out according to existing guidelines.

Study objective: The aim of the study was an analysis of the emergency treatment and outcome of anaphylaxis in children and adults according to its severity. Focus was placed on the recommended first-line therapy with adrenaline in cases of severe reactions. Further demographic data, triggers, symptoms, and hospitalization rates of anaphylaxis were analyzed.

Methods: Data from Emergency Medical Services from Dresden/Germany in cases of anaphylaxis from the start of 2012 through the end of 2016 were retrospectively analyzed. The data of the air rescue were not considered. The severity of the anaphylaxis, the therapy, the further monitoring, and the outcome were analyzed.

Results: A total of 1,131 adults and 223 children with anaphylactic reactions (Grade I-IV) were analyzed. Overall, 591 adults and 102 children showed a severe anaphylaxis. The most common trigger for severe anaphylactic reactions was food in children (61%) and medication in adults (33%). Seven percent of adults and eight percent of children with Grade II or higher anaphylactic reactions received adrenaline. There is a significant correlation between adrenaline therapy and improved condition/outcome in adults and children. Sixty-six percent of adults and 83% of children with severe anaphylaxis were hospitalized. Twenty-one percent of the adults and 13% of the children did not receive further medical observation despite a severe reaction.

Conclusion: The guideline-compliant first-line therapy with adrenaline was not carried out in the majority of the cases analyzed. However, the study shows that treatment with adrenaline for anaphylaxis leads to a significant improvement in the patients' condition.