Munblit Daniel, Treneva Marina, Korsunskiy Ilya, Asmanov Alan, Pampura Alexander, Warner John O
Department of Paediatrics, Imperial College London, London, UK.
Faculty of Pediatrics, I.M. Sechenov First Moscow State Medical University, Russia.
BMJ Open. 2017 Jul 20;7(7):e015901. doi: 10.1136/bmjopen-2017-015901.
Food allergy is an increasing burden worldwide and is a common problem within paediatric populations, affecting 5%-8% of children. Anaphylaxis caused by food proteins is a potentially life-threatening condition and all healthcare practitioners should be aware of its recognition and management. Russia is the largest country in Europe but it is still unknown whether physicians are prepared to diagnose and manage food-induced anaphylaxis effectively. We aimed to examine physicians' knowledge of diagnosis and management of food-induced anaphylaxis.
SETTING, POPULATION AND OUTCOMES: A survey was designed and published online at VrachiRF.ru website (for registered Russian-speaking practicing physicians). We obtained information on respondents' clinical settings, experience and specialty. Survey questions were based on a characteristic clinical scenario of anaphylaxis due to food ingestion. Outcome measures consisted of correct answers to the anaphylaxis diagnosis and management questions.
From a total of 707 of physicians accessed in the survey, 315 (45%) responded to the clinical scenario. 16 respondents reported training in allergy-immunology and have been excluded from the analysis, leaving the final sample size of 299. Respondents were paediatricians (68%) and other specialties adult physicians (32%). Overall, 100 (33%) of respondents diagnosed anaphylaxis, but only 29% of those making the correct diagnosis administered adrenalin (1:1000) intramuscular. Respondents working in secondary/tertiary clinics diagnosed anaphylaxis significantly more often (p=0.04) when compared with primary care/private practice physicians. This difference was also apparent as the most important influence on responses in the multivariate analysis.
In this national sample of Russian physicians, we found poor knowledge in both anaphylaxis diagnosis and management. Our data show that the chance of being properly diagnosed with anaphylaxis is 33% and being appropriately treated with adrenalin is 10%. These findings highlight lack of anaphylaxis knowledge among Russian physicians, both paediatricians and other specialists and illustrates the urgent need for allergy/anaphylaxis training.
食物过敏在全球范围内的负担日益加重，是儿科人群中的常见问题，影响着5% - 8%的儿童。食物蛋白引起的过敏反应是一种潜在的危及生命的状况，所有医疗从业者都应了解其识别和管理方法。俄罗斯是欧洲最大的国家，但医生是否准备好有效诊断和管理食物诱发的过敏反应仍不清楚。我们旨在研究医生对食物诱发过敏反应的诊断和管理知识。
背景、人群和结果：设计了一项调查并在VrachiRF.ru网站（面向注册的讲俄语的执业医生）上在线发布。我们获取了受访者的临床背景、经验和专业信息。调查问题基于因摄入食物导致过敏反应的典型临床场景。结果指标包括对过敏反应诊断和管理问题的正确答案。
在调查中访问的总共707名医生中，315名（45%）对临床场景做出了回应。16名受访者报告接受过过敏免疫培训，已被排除在分析之外，最终样本量为299。受访者为儿科医生（68%）和其他专科的成人医生（32%）。总体而言，100名（33%）受访者诊断出过敏反应，但只有29%做出正确诊断的人给予了肾上腺素（1:1000）肌肉注射。与初级保健/私人执业医生相比，在二级/三级诊所工作的受访者诊断出过敏反应的频率明显更高（p = 0.04）。在多变量分析中，这种差异也是对回答影响最重要的因素。
在这个俄罗斯医生的全国样本中，我们发现医生在过敏反应的诊断和管理方面知识匮乏。我们的数据显示，被正确诊断为过敏反应的几率为33%，而接受肾上腺素适当治疗的几率为10%。这些发现凸显了俄罗斯儿科医生和其他专科医生在过敏反应知识方面的欠缺，并表明迫切需要进行过敏/过敏反应培训。
