D3.331 - Real-World Challenges in Pediatric Anaphylaxis: The Role of Epinephrine

Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction with a rising incidence in the pediatric population. International and EAACI guidelines recommend intramuscular epinephrine as the first-line treatment. Nevertheless, real-life studies continue to report suboptimal use and delayed administration. This study aimed to evaluate the real-world use of epinephrine in pediatric anaphylaxis and to identify gaps between guideline recommendations and clinical practice.

A retrospective observational study was conducted including pediatric patients (<18 years) who presented to the emergency department of a tertiary care hospital with anaphylaxis between 2020 and 2022. Cases were identified from medical records and included if they fulfilled the NIAID/FAAN anaphylaxis criteria. Data collected included demographic characteristics and epinephrine use.

This study included 150 patients who were attended at the Pediatric Emergency Department with anaphylaxis; 32% were female and 68% male, with a mean age of 6.8 years (SD 4.9). Among these patients, 64 children (42.6%) had a previously prescribed epinephrine autoinjector; however, only 15 (23.4%) used them during the anaphylactic episode. Epinephrine was administered to the remaining patients by out-of-hospital emergency services in 16 cases (11.8%) and in the hospital emergency department in 91 cases (67.4%). 

At hospital discharge, epinephrine autoinjectors were prescribed to only 33 children, and 107 patients (71.3%) were referred to the Pediatric Allergy Unit. Of those referred, 94 children (87%) attended the specialist consultation, where epinephrine autoinjectors were subsequently prescribed in all cases. 

Data from the electronic prescription records confirmed that 124 children (82.6%) collected their epinephrine autoinjectors at least once from the pharmacy, within the first year.

The real world use of epinephrine by children with anaphylaxis remains suboptimal, even in cases with prior prescriptions. Visiting an allergy specialist emerged as a key intervention point, improving rates of patients who effectively filled their auto-injector prescriptions. These findings underscore the urgent need for education aimed at patients, caregivers, and healthcare professionals.