TY - JOUR
T1 - Factors associated with repeated use of epinephrine for the treatment of anaphylaxis
AU - Manivannan, Veena
AU - Campbell, Ronna L.
AU - Bellolio, M. Fernanda
AU - Stead, Latha G.
AU - Li, James T.C.
AU - Decker, Wyatt W.
N1 - Funding Information:
Funding Sources: This study was supported in part by a research grant from the Food Allergy and Anaphylaxis Network and the Mayo Foundation for Medical Education and Research. The study was made possible by the Rochester Epidemiology Project; grant R01-AR30582 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases; grant 1 UL1 RR024150 from the National Center for Research Resources, a component of the National Institutes of Health; and the National Institutes of Health Roadmap for Medical Research. (Researchers are independent of funders.)
PY - 2009/11
Y1 - 2009/11
N2 - Background: Studies looking at the use of repeated doses of epinephrine in patients experiencing anaphylaxis are limited. Objective: To determine which patients are most likely to receive repeated doses of epinephrine during anaphylaxis management. Methods: A population-based study with medical record review was conducted. All patients seen during the study period who met the criteria for the diagnosis of anaphylaxis were included. Results: The cohort included 208 patients (55.8% female). Anaphylaxis treatment included epinephrine in 104 patients (50.0%). Repeated doses were used in 27 patients (13.0%), 13 (48.1%) of them female. The median age of those who received repeated doses was 18.9 (interquartile range, 10-34) years vs 31.1 (interquartile range, 15-41) years for those who did not receive repeated doses (P = .06). The inciting agents were food (29.6%), insects (11.1%), medications (22.2%), others (7.4%), and unknown (29.6%). Patients who received repeated doses were more likely to have wheezing (P = .03), cyanosis (P = .001), hypotension and shock (P = .03), stridor and laryngeal edema (P = .007), nausea and emesis (P = .04), arrhythmias (P < .01), and cough (P = .04) and less likely to have urticaria (P=.049). They were more likely to be admitted to the hospital than patients who did not receive repeated doses (48.2% vs 15.6%; P < .001). There was no significant difference in the history of asthma between patients who received repeated doses and those who did not (P = .17). Conclusions: Of the patients, 13.0% received repeated epinephrine doses. Patients were younger and were likely to present with wheezing, cyanosis, arrhythmias, hypotension and shock, stridor, laryngeal edema, cough, nausea, and emesis and less likely to have urticaria. A history of asthma did not predict use of repeated doses of epinephrine. Our results help identify high-risk patients who may benefit from carrying more than 1 dose of epinephrine.
AB - Background: Studies looking at the use of repeated doses of epinephrine in patients experiencing anaphylaxis are limited. Objective: To determine which patients are most likely to receive repeated doses of epinephrine during anaphylaxis management. Methods: A population-based study with medical record review was conducted. All patients seen during the study period who met the criteria for the diagnosis of anaphylaxis were included. Results: The cohort included 208 patients (55.8% female). Anaphylaxis treatment included epinephrine in 104 patients (50.0%). Repeated doses were used in 27 patients (13.0%), 13 (48.1%) of them female. The median age of those who received repeated doses was 18.9 (interquartile range, 10-34) years vs 31.1 (interquartile range, 15-41) years for those who did not receive repeated doses (P = .06). The inciting agents were food (29.6%), insects (11.1%), medications (22.2%), others (7.4%), and unknown (29.6%). Patients who received repeated doses were more likely to have wheezing (P = .03), cyanosis (P = .001), hypotension and shock (P = .03), stridor and laryngeal edema (P = .007), nausea and emesis (P = .04), arrhythmias (P < .01), and cough (P = .04) and less likely to have urticaria (P=.049). They were more likely to be admitted to the hospital than patients who did not receive repeated doses (48.2% vs 15.6%; P < .001). There was no significant difference in the history of asthma between patients who received repeated doses and those who did not (P = .17). Conclusions: Of the patients, 13.0% received repeated epinephrine doses. Patients were younger and were likely to present with wheezing, cyanosis, arrhythmias, hypotension and shock, stridor, laryngeal edema, cough, nausea, and emesis and less likely to have urticaria. A history of asthma did not predict use of repeated doses of epinephrine. Our results help identify high-risk patients who may benefit from carrying more than 1 dose of epinephrine.
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U2 - 10.1016/S1081-1206(10)60358-4
DO - 10.1016/S1081-1206(10)60358-4
M3 - Article
C2 - 19927537
AN - SCOPUS:73349133347
SN - 1081-1206
VL - 103
SP - 395
EP - 400
JO - Annals of Allergy, Asthma and Immunology
JF - Annals of Allergy, Asthma and Immunology
IS - 5
ER -