Allergy Asthma Immunol Res.  2019 Jul;11(4):529-537. 10.4168/aair.2019.11.4.529.

Underuse of Epinephrine for Pediatric Anaphylaxis Victims in the Emergency Department: A Population-based Study

• Choi YJ
• Kim J
• Jung JY
• Kwon H
• Park JW

• KMID: 2448755
• DOI: http://doi.org/10.4168/aair.2019.11.4.529

Abstract

PURPOSE
Epinephrine is a key drug for treating anaphylaxis; however, its underuse is still a significant issue worldwide. The objective of this study was to compare epinephrine use between pediatric and adult patients who were treated with anaphylaxis in the emergency department (ED).
METHODS
The data were retrieved from the National Sample Cohort of South Korea, which contains claim data from the National Health Insurance Service. We included patients who visited the ED with a discharge code of anaphylaxis between 2004 and 2013. We assessed prescription information of epinephrine, antihistamine and systemic steroid, previous medical history and discharge disposition from the ED. The study population was categorized based on age at the visit.
RESULTS
A total of 175 pediatric and 1,605 adult patients with anaphylaxis were identified. Only 42 (24%) of the pediatric patients were treated with epinephrine, while 592 (36.9%) of the adult patients were treated with epinephrine (P = 0.001). Furthermore, the pediatric patients were less likely to be treated with systemic steroid than the adult patients (6.9% vs. 12.3%, P = 0.047). The odds ratios for the administration of epinephrine relative to the baseline in the 19-65 age group were 0.34 (95% confidence interval [CI], 0.15-0.67), 0.56 (95% CI, 0.28-1.03) and 0.79 (95% CI, 0.45-1.33) in the < 7, 7-12 and 13-18 age groups, respectively.
CONCLUSIONS
The pediatric patients with anaphylaxis experienced a lower rate of epinephrine injection use than the adult patients and the injection use decreased as age decreased.

Keyword

Anaphylaxis; epinephrine; pediatric

MeSH Terms

Adult
Anaphylaxis*
Cohort Studies
Emergencies*
Emergency Service, Hospital*
Epinephrine*
Humans
Korea
National Health Programs
Odds Ratio
Prescriptions
Epinephrine

Figure

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  Figure Rate comparison of medication use by age group.

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