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Insect Sting Allergies May Not Be Treated Properly In Emergency Departments

A recent study featured in the September 2005 Journal of Allergy & Clinical Immunology (JACI) shows emergency departments often do not follow recommended treatment guidelines when treating severe allergic reactions to insect stings. The JACI is the peer-reviewed, scientific journal of the American Academy of Allergy, Asthma & immunology (AAAAI).

The researchers reviewed 15 North American emergency departments. Sunday Clark, ScD, from the Department of Emergency Medicine at Massachusetts General Hospital and colleagues examined the medical records of 617 patients with insect sting allergies.

The researchers found that, among the patients, 58% had local reactions, 11% had mild systemic reactions, and 31% experienced anaphylaxis. Anaphylaxis is a sudden, severe allergic reaction that is potentially life-threatening. Symptoms of anaphylaxis range from itching and hives over large areas of the body, throat or tongue swelling to a quick fall in blood pressure that can result in loss of consciousness and death.

The study also found that while patients were in the emergency department, only 12% of the patients with mild or severe allergic reactions received epinephrine, the recommended treatment for severe reactions to insect stings. However, 69% of the patients received antihistamines, while 50% received systemic corticosteroids. When leaving the emergency department, only 31% of the patients with mild or severe allergic reactions received a prescription for self-injectable epinephrine. A small percentage of the patients, only 21%, were referred to an allergist/immunologist for further assessment and discussion of insect sting allergy management.

"Because the ED is the most common medical setting for diagnosing and treating anaphylaxis, advances in anaphylaxis management will need the active participation of emergency medicine clinicians and researchers," said Carlos Camargo, MD, FAAAAI, emergency physician at Massachusetts General Hospital and coauthor of the study.

Epinephrine is recommended as the gold standard for treatment in current guidelines for treating patients with severe allergic reactions. Guidelines also recommend that patients be taught the proper techniques for self-administration of epinephrine for the next time the patient is stung and that patients are referred to an allergist/immunologist for further management of their allergies. While these are the recommended treatment guidelines, this study demonstrates that compliance with recommended treatment guidelines is low, even among those patients who come into the emergency department with severe reactions.

"This study demonstrates an opportunity for ED staff to guide patients with potentially life-threatening allergies toward better allergy management," Camargo said.

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