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Factors associated with repeated use of epinephrine for the treatment of anaphylaxis.

Abstract

BACKGROUND
Studies looking at the use of repeated doses of epinephrine in patients experiencing anaphylaxis are limited.
OBJECTIVE
To determine which patients are most likely to receive repeated doses of epinephrine during anaphylaxis management.
METHODS
A population-based study with medical record review was conducted. All patients seen during the study period who met the criteria for the diagnosis of anaphylaxis were included.
RESULTS
The cohort included 208 patients (55.8% female). Anaphylaxis treatment included epinephrine in 104 patients (50.0%). Repeated doses were used in 27 patients (13.0%), 13 (48.1%) of them female. The median age of those who received repeated doses was 18.9 (interquartile range, 10-34) years vs 31.1 (interquartile range, 15-41) years for those who did not receive repeated doses (P = .06). The inciting agents were food (29.6%), insects (11.1%), medications (22.2%), others (7.4%), and unknown (29.6%). Patients who received repeated doses were more likely to have wheezing (P = .03), cyanosis (P = .001), hypotension and shock (P = .03), stridor and laryngeal edema (P = .007), nausea and emesis (P = .04), arrhythmias (P < .01), and cough (P = .04) and less likely to have urticaria (P = .049). They were more likely to be admitted to the hospital than patients who did not receive repeated doses (48.2% vs 15.6%; P < .001). There was no significant difference in the history of asthma between patients who received repeated doses and those who did not (P = .17).
CONCLUSIONS
Of the patients, 13.0% received repeated epinephrine doses. Patients were younger and were likely to present with wheezing, cyanosis, arrhythmias, hypotension and shock, stridor, laryngeal edema, cough, nausea, and emesis and less likely to have urticaria. A history of asthma did not predict use of repeated doses of epinephrine. Our results help identify high-risk patients who may benefit from carrying more than 1 dose of epinephrine.

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  • Authors

    Manivannan V, Campbell RL, Bellolio MF, Stead LG, Li JT, Decker WW

    Institution

    Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

    Source

    Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 103:5 2009 Nov pg 395-400

    MeSH

    Adolescent
    Adult
    Age Factors
    Anaphylaxis
    Child
    Cohort Studies
    Cyanosis
    Drug Administration Schedule
    Epinephrine
    Female
    Humans
    Hypotension
    Laryngeal Edema
    Male
    Medical Records
    Nausea
    Respiratory Sounds
    Shock
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19927537