Use of epinephrine in emergency department depends on anaphylaxis severity in children.


:Despite multiple recommendations, intramuscular epinephrine is poorly prescribed in emergency department receiving pediatric anaphylaxis. To evaluate the role of severity symptoms on this use, we included all admissions for a diagnosis linked to possible allergy in the two pediatric emergency departments of our institution between January 2010 and December 2015. Selection and analysis were restricted to children under 18 years fulfilling Sampson's criteria for anaphylaxis. We retrospectively ranked these admissions with the Ring and Messmer anaphylaxis severity score and compared the use of epinephrine according to this classification. Among 422,483 admissions, 204 (0.05%) fulfilled the anaphylaxis criteria (170 (83.3%) grade II anaphylaxis, and 34 (16.7%) grade III; mean age 7.9 years). Previous allergy, anaphylaxis, and asthma were found in respectively 60.8%, 36.8%, and 35.1%. Food allergy was the main suspected causal trigger. Epinephrine was used in 32.7% (n = 65/199), before admission (11.4% (n = 23/201)) or in the emergency department (22.2% (n = 45/202)). Epinephrine was more frequently prescribed in grade III than in grade II anaphylaxis (84.8% vs 22.3%, p < 0.001; OR = 19.05 [7.05-54.10]). Upon discharge, epinephrine auto-injectors prescription and allergy referral were rare (31.7% and 44.2%).Conclusion: Pediatricians intuitively adapt their epinephrine use to the severity of the anaphylaxis and contribute to epinephrine underuse in pediatric anaphylaxis. What is known: • Intramuscular epinephrine is the recommended treatment for pediatric anaphylaxis. However, most of the European and North-American studies show a low prescription rate of epinephrine in both prehospital and pediatric emergency department management. • Reasons for such a low prescription rate are unknown. What is new: • This study confirms that intramuscular epinephrine is poorly prescribed in pediatric anaphylaxis (about one case among 10 before admission and one among 5 in pediatric emergency departments). • Despite recommendations, pediatricians intuitively adapt their prescription to the clinical severity of anaphylaxis, with a fourfold increase prescription in grade III compared to grade II anaphylaxis. This medical behavior ascertainment may be in part explained by the delay between the ED admission/management and the anaphylactic episode onset.


Eur J Pediatr


Dubus JC,Lê MS,Vitte J,Minodier P,Boutin A,Carsin A,Viudes G,Noel G




Has Abstract


2019-01-01 00:00:00














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    更新日期:1995-08-01 00:00:00

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    authors: Urban C,Sager WD

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  • Long-term outcomes in pediatric appendiceal carcinoids: Turkey experience.

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  • Nemaline myopathy in the neonate: two case reports.

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    authors: Vendittelli F,Manciet-Labarchède C,Gilbert-Dussardier B

    更新日期:1996-06-01 00:00:00

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    更新日期:2004-04-01 00:00:00

  • Primary ciliary dyskinesia, an orphan disease.

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    authors: Boon M,Jorissen M,Proesmans M,De Boeck K

    更新日期:2013-02-01 00:00:00

  • The Kabuki (Niikawa-Kuroki) syndrome: further delineation of the phenotype in 29 non-Japanese patients.

    abstract::The Kabuki (Niikawa-Kuroki) syndrome was reported in 1981 by Niikawa et al. and Kuroki et al. in a total of ten unrelated Japanese children with a characteristic array of multiple congenital anomalies and mental retardation. The syndrome is characterized by a distinct face, mild to moderate mental retardation, postnat...

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    pub_type: 杂志文章


    authors: Schrander-Stumpel C,Meinecke P,Wilson G,Gillessen-Kaesbach G,Tinschert S,König R,Philip N,Rizzo R,Schrander J,Pfeiffer L

    更新日期:1994-06-01 00:00:00

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    pub_type: 杂志文章


    authors: Cremer P,Lakomek M,Beck W,Prindull G

    更新日期:1988-01-01 00:00:00

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    abstract:UNLABELLED:Lymphocytic hypophysitis is a rare disorder predominantly affecting females during the antepartum or postpartum period. It is characterized by destruction and lymphocytic infiltration of the pituitary gland, probably by an autoimmune process, leading to a pituitary mass lesion and/or various degrees of hypop...

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    authors: Cemeroglu AP,Blaivas M,Muraszko KM,Robertson PL,Vázquez DM

    更新日期:1997-09-01 00:00:00

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    authors: Riordan FA,Bestwick K,Thomson AP,Sills JA,Hart CA

    更新日期:1997-06-01 00:00:00

  • Bone marrow hypoplasia in anorexia nervosa.

    abstract::Within a 2-year period, from March 1974 until May 1976 10 patients with anorexia nervosa were seen at the children's university hospitals of München (2 patients) and Giessen (8 patients). The patients were 10-16 years old, with one exception all girls, and had the typical cachexia, hypothermia, bradycardia, gray, hair...

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    authors: Lampert F,Lau B

    更新日期:1976-12-09 00:00:00

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    authors: Humbert M,Labrune P,Simonneau G

    更新日期:2002-10-01 00:00:00

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    authors: Amizuka T,Shimizu H,Niida Y,Ogawa Y

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    authors: Massin MM,Nitsch GB,Däbritz S,Seghaye MC,Messmer BJ,von Bernuth G

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    journal_title:European journal of pediatrics

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    authors: Steinlin M,Roellin K,Schroth G

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  • High-frequency oscillatory ventilation in paediatric patients with acute respiratory distress syndrome--early rescue use.

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    authors: Ben Jaballah N,Mnif K,Bouziri A,Kazdaghli K,Belhadj S,Zouari B

    更新日期:2005-01-01 00:00:00

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    abstract:: ...

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    authors: Coraci D,Giovannini S,Loreti C,Erra C,Padua L

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    authors: Ulrichs T,Fieschi C,Nevicka E,Hahn H,Brezina M,Kaufmann SH,Casanova JL,Frecerova K

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  • New insights into lipid and fatty acid metabolism via stable isotopes.

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    authors: Demmelmair H,Sauerwald T,Koletzko B,Richter T

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    authors: Wudy SA,Homoki J,Teller WM

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    abstract:UNLABELLED:Growth hormone (GH) secretion was determined by evaluating circadian GH profiles for 24 h and GH responses to clonidine stimulation test and insulin-stimulated hypoglycaemia (ITT), in nine prepubertal children with beta-thalassaemia major (TM) and 17 with non-GH deficient short stature (NGHDSS). The TM child...

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    authors: Katzos G,Harsoulis F,Papadopoulou M,Athanasiou M,Sava K

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    authors: Raine J,Redington AN,Benatar A,Samuels MP,Southall DP

    更新日期:1993-07-01 00:00:00

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    abstract::Growth hormone (GH) secretion was determined by evaluating ultradian GH profiles for 12 h and GH responses to insulin stimulated hypoglycaemia (ITT) in 28 stunted boys with beta-thalassaemia major aged 15.2-17.4 years, who presented with pubertal failure (FP). Healthy non thalassaemia prepubertal boys (n = 10) aged 7....

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    authors: Chatterjee R,Katz M,Cox T,Bantock H

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    authors: Shiohara M,Mori T,Mei B,Brown EM,Watanabe T,Yasuda T

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