Knowledge of anaphylaxis among Emergency Department staff

BACKGROUND: Anaphylaxis is an emergency condition that requires immediate, accurate diagnosis and appropriate management. However, little is known about the level of knowledge of doctors and nurses treating these patients in the Emergency Department. OBJECTIVE: To determine the knowledge of doctors and nurses in the Emergency Department on the recent definition and treatment recommendations of anaphylaxis. METHODS: We surveyed doctors and nurses of all grades in a tertiary Hospital Emergency Department using a standardized anonymous questionnaire. RESULTS: We had a total of 190 respondents-47 doctors and 143 nurses. The response rate was 79.7% for doctors and 75.3% for nurses. Ninety-seven point eight percent of the doctors and 83.7% of the nurses chose the accepted definition of anaphylaxis. High proportions of doctors (89-94%) and nurses (65-72%) diagnose anaphylaxis in the three scenarios demonstrating anaphylaxis and anaphylactic shock. Forty-two point six percent of the doctors and 76.9% of the nurses incorrectly diagnosed single organ involvement without hypotension as anaphylaxis. As for treatment, 89.4% of the doctors indicated adrenaline as the drug of choice and 85.1% chose intramuscular route for adrenaline administration. Among the nurses, 40.3% indicated adrenaline as the drug of choice and 47.4% chose the intramuscular route for adrenaline. CONCLUSION: High proportion of doctors and nurses are able to recognize the signs and symptoms of anaphylaxis, although there is a trend towards over diagnosis. There is good knowledge on drug of choice and the accepted route of adrenaline among the doctors. However, knowledge of treatment of anaphylaxis among nurses was moderate and can be improved.

Clinical characteristics and outcomes of patients undergoing drug provocation tests (DPTs)

<p><b>INTRODUCTION</b>Patients who have an adverse drug reaction are frequently labelled drug allergic without undergoing proper evaluation and confirmatory testing. These drug allergy labels may be inaccurate, leading to unnecessary lifelong avoidance. The aim of this study was to review the patients that underwent drug provocation tests (DPTs) in our centre and examine the usefulness of DPTs in confirming or rejecting a diagnosis of drug hypersensitivity.</p><p><b>MATERIALS AND METHODS</b>The study design was a retrospective chart review of all adult patients who underwent drug provocation in the allergy unit at the National University Hospital, Singapore, for single or multiple suspected drug allergies from the period January 2009 to June 2011.</p><p><b>RESULTS</b>Eighty-seven patients underwent 123 DPTs (median age 41; interquartile range 28 to 50). Twenty-one patients underwent multiple DPTs. The most common culprit drugs reported were antibiotics (43.9%) of which beta-lactams were implicated in 75.9% of the cases. This was followed by non-steroidal anti-inflammatory drugs (NSAIDS) in 15.4%, paracetamol in 7.3% and both NSAIDs and paracetamol in 3.3%. Rash was the most commonly reported symptom (41.5%), followed by angioedema (32.5%), anaphylaxis (9.8%), and other symptoms including respiratory (2.4%), gastrointestinal (0.8%) and others (13.0%). The majority of DPTs were performed to antibiotics (43.9%), NSAIDs (19.5%) and paracetamol (6.5%). DPTs were negative in 93.5% of subjects and positive in 6.5%. Of the 8 positive DPTs, none had a serious reaction, with 5 patients requiring rescue therapy, which comprised solely of oral antihistamines.</p><p><b>CONCLUSION</b>Suspected drug hypersensitivity is common but true drug allergy is rare. DPTs remain the gold standard and should be included as part of an investigative protocol. DPTs are a safe and valuable diagnostic tool in the hands of the experienced clinician.</p>