Asthma and Epinephrine Administration Prior to Emergency Department Presentation for Suspected Anaphylaxis in Pediatric Patients

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Hong, Billy
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Anaphylaxis is a potentially life-threatening systemic allergic reaction that involves at least two organs or systems and may result in hypotension. The mainstay of anaphylaxis treatment is epinephrine, and as such, individuals with severe allergies are recommended to carry epinephrine auto-injectors (EAIs). However, there is a substantial underutilization of EAIs for the management of anaphylaxis. One of the challenges that hinders early anaphylaxis diagnosis and management is its similarity to asthma with respect to immunopathology, clinical presentation, response to therapies, and natural history. While asthma and anaphylaxis frequently coexist and mimic each other, the exact influence of the two conditions on each other has yet to be fully explained. In the current study using data from the Cross-Canada Anaphylaxis registry (C-CARE), univariable and multivariable logistic regressions were performed to examine the association between comorbid asthma and both pre-hospital and overall epinephrine treatment. It was identified that the presence of comorbid asthma asthma was not associated with the use of pre-hospital epinephrine in the treatment of anaphylaxis and is associated with a decreased likelihood of receiving epinephrine overall. Given this finding, and the current substantial underutilization of EAIs, it is more important than ever to improve EAI prescribing practices and educate patients with allergies and relevant caregivers on prompt and safe EAI use.