• Sofianne Gabrielli, Ann Clarke, Judy Morris, Harley Eisman, Jocelyn Gravel, Paul Enarson, Edmond S Chan, Andrew O'Keefe, Robert Porter, Rodrick Lim, Yarden Yanishevsky, Jennifer Gerdts, Adil Adatia, Sebastien LaVieille, Xun Zhang, and Moshe Ben-Shoshan.
• Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: sofiannegabrielli@gmail.com.
• J Allergy Clin Immunol Pract. 2019 Sep 1; 7 (7): 2232-2238.e3.

BackgroundStudies assessing the use of antihistamines and corticosteroids for the treatment of anaphylaxis have not supported a conclusive effect.ObjectiveTo assess prehospital management of anaphylaxis by measuring the effect of epinephrine use compared with antihistamines and corticosteroids on negative outcomes of anaphylaxis (intensive care unit/hospital ward admission, multiple doses of epinephrine in the emergency department [ED], and intravenous fluids given in the ED).MethodsThe Cross-Canada Anaphylaxis Registry is a cohort study that enrolls anaphylaxis cases presenting to EDs in 5 Canadian provinces over a 6-year period. Participants were recruited prospectively and retrospectively and were excluded if the case did not meet the definition of anaphylaxis.ResultsA total of 3498 cases of anaphylaxis, of which 80.3% were children, presented to 9 EDs across Canada. Prehospital treatment with epinephrine was administered in 31% of cases, whereas antihistamines and corticosteroids were used in 46% and 2% of cases, respectively. Admission to the intensive care unit/hospital ward was associated with prehospital treatment with corticosteroids (adjusted odds ratio, 2.84; 95% confidence interval [CI], 1.55, 6.97) while adjusting for severity, treatment with epinephrine and antihistamines, asthma, sex, and age. Prehospital treatment with epinephrine (adjusted odds ratio, 0.23; 95% CI, 0.14, 0.38) and antihistamines (adjusted odds ratio, 0.61; 95% CI, 0.44, 0.85) decreased the likelihood of receiving multiple doses of epinephrine in the ED, while adjusting for severity, treatment with corticosteroids, asthma, sex, and age.ConclusionsPrompt epinephrine treatment is crucial. Use of antihistamines in conjunction with epinephrine may reduce the risk of uncontrolled reactions (administration of 2 or more doses of epinephrine in the ED), although our findings do not support the use of corticosteroids.Copyright © 2019 American Academy of Allergy, Asthma & Immunology. All rights reserved.

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