Lin Yen-Yue, Chang Hsin-An, Kao Yung-Hsi, Chuu Chih-Pin, Chiang Wen-Fang, Chang Ya-Chieh, Li Yuan-Kuei, Chu Chi-Ming, Chan Jenq-Shyong, Hsiao Po-Jen
Department of Emergency, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.
Department of Emergency, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Front Med (Lausanne). 2023 Jul 7;10:1163817. doi: 10.3389/fmed.2023.1163817. eCollection 2023.
Anaphylaxis is a potentially fatal condition; in severe cases of anaphylaxis, the cardiovascular system is often heavily involved. Adrenaline (epinephrine) is a cornerstone of the initial treatment of anaphylaxis. The use of epinephrine remains below expectations in clinical practice. Whether the underuse of epinephrine affects the prognosis of patients with anaphylaxis is still unclear.
This retrospective study included patients with anaphylaxis between 2011 and 2020 who were admitted to an emergency department (ED) in Taiwan. All patients were divided into two groups based on the use of epinephrine (or not), and we compared the demographic characteristics, allergens, clinical manifestations, management, and patient outcomes.
We reviewed the records of 314 subjects (216 males, 98 females; mean age: 52.78 ± 16.02 years) who visited our ED due to anaphylaxis; 107 (34.1%) and 207 (65.9%) patients were categorized into the epinephrine use group and the non-epinephrine use group, respectively. Arrival via ambulance ( 0.019), hypotension ( = 0.002), airway compromise ( < 0.001) and altered consciousness ( < 0.001) were the deciding factors for epinephrine use among anaphylactic patients in the ED. The epinephrine use group had higher rates of other inotropic agent usage and fluid challenge. More than 90% of patients received bed rest, steroids, antihistamines, and monitoring. The epinephrine use group had a longer ED length of stay (387.64 ± 374.71 vs. 313.06 ± 238.99 min, = 0.03) and a greater need of hospitalization. Among all severe symptoms, hypotension was the most tolerated decision factor for not using epinephrine. In this retrospective analysis, some patients with serious anaphylaxis did not experience adverse outcomes or death even without the use of epinephrine at ED admission. Emergent care focuses first on the airway, breathing, and circulation (ABC) and may compensate for the underusage of epinephrine. This could be the reason why epinephrine was underused among patients with anaphylaxis in the ED.
In summary, early ABC management continues to play an important role in treating patients with severe anaphylaxis, even when epinephrine is not immediately available in clinical scenarios.
过敏反应是一种可能致命的疾病；在严重的过敏反应病例中，心血管系统常受到严重影响。肾上腺素是过敏反应初始治疗的基石。在临床实践中，肾上腺素的使用仍未达预期。肾上腺素使用不足是否会影响过敏反应患者的预后尚不清楚。
这项回顾性研究纳入了2011年至2020年间因过敏反应入住台湾某急诊科的患者。所有患者根据是否使用肾上腺素分为两组，我们比较了人口统计学特征、过敏原、临床表现、治疗措施及患者结局。
我们回顾了314例因过敏反应前来我院急诊科就诊的患者记录（男性216例，女性98例；平均年龄：52.78±16.02岁）；107例（34.1%）和207例（65.9%）患者分别被归入肾上腺素使用组和非肾上腺素使用组。通过救护车送达（=0.019）、低血压（=0.002）、气道梗阻（<0.001）和意识改变（<0.001）是急诊科过敏反应患者使用肾上腺素的决定因素。肾上腺素使用组使用其他正性肌力药物和液体复苏的比例更高。超过90%的患者接受了卧床休息、使用类固醇、抗组胺药及监测。肾上腺素使用组的急诊科住院时间更长（387.64±374.71分钟 vs. 313.06±238.99分钟，=0.03），且更需要住院治疗。在所有严重症状中，低血压是不使用肾上腺素最可耐受的决定因素。在这项回顾性分析中，一些严重过敏反应患者即使在急诊科入院时未使用肾上腺素也未出现不良结局或死亡。紧急护理首先关注气道（A）、呼吸（B）和循环（C），可能弥补了肾上腺素使用不足的情况。这可能是急诊科过敏反应患者肾上腺素使用不足的原因。
总之，即使在临床场景中无法立即获得肾上腺素，早期的ABC管理在治疗严重过敏反应患者中仍继续发挥重要作用。
