Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada.
Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada.
J Allergy Clin Immunol Pract. 2021 Jun;9(6):2321-2333. doi: 10.1016/j.jaip.2021.01.038. Epub 2021 Feb 4.
Community use of epinephrine for the treatment of anaphylaxis is low. Knowledge of rates of epinephrine use in the pre-hospital setting along with identification of barriers to its use will contribute to the development of policies and guidelines.
A search was conducted on PubMed and Embase in April 2020. Our systematic review focused on 4 domains: (1) epinephrine use in the pre-hospital setting; (2) barriers to epinephrine use in the pre-hospital setting; (3) cost evaluation and cost-effectiveness of epinephrine use; and (4) programs and strategies to improve epinephrine use during anaphylaxis.
Two meta-analyses with logit transformation were conducted to: (1) calculate the pooled estimate of the rate of epinephrine use in the pre-hospital setting among cases of anaphylaxis and (2) calculate the pooled estimate of the rate of biphasic reactions among all cases of anaphylaxis.
Epinephrine use in the pre-hospital setting was significantly higher for children compared with adults (20.98% [95% confidence interval (CI): 16.38%, 26.46%] vs 7.17% [95% CI: 2.71%, 17.63%], respectively, P = .0027). The pooled estimate of biphasic reactions among all anaphylaxis cases was 3.92% (95% CI: 2.88%, 5.32%). Our main findings indicate that pre-hospital use of epinephrine in anaphylaxis remains suboptimal. Major barriers to the use of epinephrine were identified as low prescription rates of epinephrine autoinjectors and lack of stock epinephrine in schools, which was determined to be cost-effective. Finally, in reviewing programs and strategies, numerous studies have engineered effective methods to promote adequate and timely use of epinephrine.
The main findings of our study demonstrated that across the globe, prompt epinephrine use in cases of anaphylaxis remains suboptimal. For practical recommendations, we would suggest considering stock epinephrine in schools and food courts to increase the use of epinephrine in the community. We recommend use of pamphlets in public areas (ie, malls, food courts, etc.) to assist in recognizing anaphylaxis and after that with prompt epinephrine administration, to avoid the rare risk of fatality in anaphylaxis cases.
社区中使用肾上腺素治疗过敏反应的情况很少。了解院前环境中使用肾上腺素的比率以及确定其使用的障碍将有助于制定政策和指南。
2020 年 4 月在 PubMed 和 Embase 上进行了检索。我们的系统评价重点关注 4 个领域：（1）院前环境中肾上腺素的使用；（2）院前环境中肾上腺素使用的障碍；（3）肾上腺素使用的成本评估和成本效益；（4）改善过敏反应期间肾上腺素使用的计划和策略。
进行了 2 项对数转换的荟萃分析，以：（1）计算过敏反应病例中院前环境中肾上腺素使用率的汇总估计值；（2）计算所有过敏反应病例中双相反应的汇总估计值。
与成人相比，儿童在院前环境中使用肾上腺素的比例明显更高（分别为 20.98%[95%置信区间（CI）：16.38%，26.46%]和 7.17%[95%CI：2.71%，17.63%]，P=.0027）。所有过敏反应病例中双相反应的汇总估计值为 3.92%（95%CI：2.88%，5.32%）。我们的主要发现表明，过敏反应的院前使用肾上腺素仍然不理想。使用肾上腺素的主要障碍是肾上腺素自动注射器的处方率低，学校缺乏肾上腺素库存，这被确定为具有成本效益。最后，在审查计划和策略时，许多研究都设计了有效方法来促进肾上腺素的充分和及时使用。
我们的研究主要发现表明，在全球范围内，过敏反应病例中及时使用肾上腺素仍然不理想。为了提供实际建议，我们建议考虑在学校和美食广场储备肾上腺素，以增加社区中肾上腺素的使用。我们建议在公共场所（如购物中心、美食广场等）使用宣传册来帮助识别过敏反应，然后迅速给予肾上腺素治疗，以避免过敏反应病例中罕见的死亡风险。
