Gunderson Carly A, Lopez Sandra M, Lukose Karishma, Akar-Ghibril Nicole
Division of Immunology, Allergy and Rheumatology, Memorial Healthcare System, Hollywood, Florida.
Division of Emergency Medicine, Memorial Healthcare System, Hollywood, Florida.
Ann Allergy Asthma Immunol. 2025 Jul;135(1):91-96. doi: 10.1016/j.anai.2025.03.021. Epub 2025 Mar 29.
Across the United States, there are significant inconsistencies in the protocols used by emergency medical services (EMS) in the prehospital treatment of anaphylaxis. These discrepancies include variations in the definition of anaphylaxis and treatment recommendations.
To identify gaps in the recognition of anaphylaxis and to provide areas for improvement in prehospital management through an analysis of state-wide anaphylaxis protocols.
States with mandatory or model state-wide protocols were included (total of 30). Each allergic reaction and/or anaphylaxis protocol was reviewed-emphasis was placed on the definitions used to identify reactions and treatment algorithms.
Of the 30 states, only 50% (15) included gastrointestinal symptoms in the definition of anaphylaxis and only 40% (12) included neurologic manifestations. In addition, 47% (14) used a 2-organ system definition. For anaphylactic reactions, 100% (30) of the protocols recommended diphenhydramine and epinephrine. However, 90% (27) recommended albuterol, if respiratory symptoms were present, and 60% (18) recommended steroids. Epinephrine was the first-line recommendation for anaphylaxis in 97% (29) of the protocols. Overall, 25 states (83%) allowed epinephrine autoinjectors and 17 (57%) provided autoinjectors.
Many EMS anaphylaxis protocols are incomplete and/or outdated. Many protocols do not consider gastrointestinal or neurologic manifestations. In addition, many contain outdated recommendations, including the use of steroids and first-generation antihistamines. Despite the convenience of epinephrine autoinjectors, many protocols do not permit or provide them. Given the frequency of EMS activation for allergic reactions, our communities would benefit from standardized protocols using current evidence-based guidelines for the management of anaphylaxis.
在美国各地，紧急医疗服务（EMS）在院前过敏性反应治疗中所使用的方案存在显著差异。这些差异包括过敏性反应定义和治疗建议的不同。
通过分析全州范围的过敏性反应方案，找出过敏性反应识别方面的差距，并为院前管理提供改进领域。
纳入具有强制性或全州示范方案的州（共30个）。对每个过敏反应和/或过敏性反应方案进行审查，重点关注用于识别反应的定义和治疗算法。
在30个州中，只有50%（15个）在过敏性反应定义中纳入了胃肠道症状，只有40%（12个）纳入了神经学表现。此外，47%（14个）使用了双器官系统定义。对于过敏反应，100%（30个）的方案推荐使用苯海拉明和肾上腺素。然而，90%（27个）建议在出现呼吸道症状时使用沙丁胺醇，60%（18个）建议使用类固醇。在97%（29个）的方案中，肾上腺素是过敏性反应的一线推荐药物。总体而言，25个州（83%）允许使用肾上腺素自动注射器，17个州（57%）提供自动注射器。
许多EMS过敏性反应方案不完整和/或过时。许多方案未考虑胃肠道或神经学表现。此外，许多方案包含过时的建议，包括使用类固醇和第一代抗组胺药。尽管肾上腺素自动注射器使用方便，但许多方案不允许使用或不提供。鉴于因过敏反应而启动EMS的频率较高，我们的社区将受益于采用当前基于证据的过敏性反应管理指南的标准化方案。
