Current recommendations regarding anaphylaxis management include the use of adrenaline (epinephrine), H1-antihistamines and corticosteroids. While rapid adrenaline is widely used, previous studies are inconclusive concerning the use of antihistamines and corticosteroids as first-line treatment. A recent cohort study has evaluated pre-hospital management of anaphylaxis by examining 3,498 cases (80.3% children) across 9 emergency departments over a period of six years. The effects of using adrenaline in comparison to antihistamines and corticosteroids were measured by assessing intensive care/hospital ward admission, and the number of adrenaline doses and the use of intravenous fluids required in the ED. Pre-hospital adrenaline, antihistamines and corticosteroids were seen in 31%, 46% and 2% of cases, respectively. Intensive care/hospital ward admission was linked to those who received corticosteroid treatment (adjusted odds ratio: 2.84, 95% CI: 1.55 – 6.97) and the probability of receiving numerous doses of adrenaline in the ED was reduced in those treated with adrenaline (adjusted odds ratio: 0.23, 95% CI: 0.14 – 0.38) and antihistamines (adjusted odds ratio: 0.61, 95% CI: 0.44 – 0.85). The study, which can be viewed here, supports antihistamine use in combination with adrenaline, but highlights negative effects associated with early corticosteroid use and suggests modification of current guidelines to provide optimal pre-hospital anaphylaxis management is probably required.

Contributed by Australian Medication Safety Services Associate – Isabella Singh