Ifikhar Jazeb, Sparks Darby, Hendrix-Dicken Amy D, Folger Sydney, Hartwell Micah, Condren Michelle
University of Oklahoma School of Community Medicine, Department of Pediatrics, 4502 E 41st St, Tulsa, OK 74135, USA.
University of Oklahoma School of Community Medicine, Department of Pediatrics, 4502 E 41st St, Tulsa, OK 74135, USA.
Am J Emerg Med. 2025 Aug;94:197-200. doi: 10.1016/j.ajem.2025.04.055. Epub 2025 Apr 29.
In recent years, the medical community's view on diphenhydramine for urticaria and anaphylaxis has shifted due to its side effects and the efficacy of second-generation antihistamines. The AAAAI's 2020 anaphylaxis guidelines discourage the use of first-generation antihistamines in the acute phase or to prevent biphasic reactions.
Our study aimed to evaluate the usage of diphenhydramine in US emergency departments (EDs) for treating anaphylaxis and urticaria between 2019 and 2021, while also investigating the potential impact of the 2020 AAAAI guidelines on its utilization.
A cross-sectional analysis was conducted using data from the Centers for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey (NHAMCS) spanning 2019-2021. NHAMCS collects nationwide data on patient visits to various healthcare facilities. This study focused on emergency department (ED) data, specifically examining patients with ICD-10 codes for anaphylaxis or urticaria who received at least one prescribed/given medication. Diphenhydramine administration was identified based on drug records. Design-based Pearson chi-square analysis with a significance threshold of P < .050 was employed.
Out of 450 cases with anaphylaxis and/or urticaria, 61.99 % (n = 276) involved diphenhydramine administration. Rates for anaphylaxis, urticaria, and both conditions were 57.99 % (n = 170), 69.45 % (n = 88), and 73.4 % (n = 18) respectively. No significant change in diphenhydramine use from 2019 to 2021 was found (P = .9421).
Our study indicates stagnant ED practices regarding diphenhydramine despite evolving guidelines. Bridging the gap between evidence and practice is crucial for patient care for urticaria and anaphylaxis. Future research should identify barriers hindering guideline adoption in US EDs.
近年来，由于苯海拉明的副作用以及第二代抗组胺药的疗效，医学界对其用于治疗荨麻疹和过敏反应的看法有所转变。美国过敏、哮喘与免疫学会（AAAAI）2020年的过敏反应指南不鼓励在急性期使用第一代抗组胺药或预防双相反应。
我们的研究旨在评估2019年至2021年期间美国急诊科使用苯海拉明治疗过敏反应和荨麻疹的情况，同时调查2020年AAAAI指南对其使用的潜在影响。
使用疾病控制与预防中心的国家医院门诊医疗调查（NHAMCS）2019 - 2021年的数据进行横断面分析。NHAMCS收集全国范围内患者到各类医疗机构就诊的数据。本研究聚焦于急诊科数据，具体检查具有国际疾病分类第十版（ICD - 10）过敏反应或荨麻疹编码且接受至少一种处方/给予药物治疗的患者。根据药物记录确定苯海拉明的使用情况。采用基于设计的Pearson卡方分析，显著性阈值为P < 0.050。
在450例过敏反应和/或荨麻疹病例中，61.99%（n = 276）使用了苯海拉明。过敏反应、荨麻疹以及两种情况都有的使用率分别为57.99%（n = 170）、69.45%（n = 88）和73.4%（n = 18）。未发现2019年至2021年苯海拉明的使用有显著变化（P = 0.9421）。
我们的研究表明，尽管指南不断演变，但急诊科在使用苯海拉明方面的做法停滞不前。缩小证据与实践之间的差距对于荨麻疹和过敏反应患者的护理至关重要。未来的研究应确定阻碍美国急诊科采用指南的障碍。
