Changes in Emergency Department Concordance with Guidelines for the Management of Food-Induced Anaphylaxis: 1999-2001 Versus 2013-2015

Abstract Background Awareness about food allergy and food-induced anaphylaxis (FIA) has increased dramatically over the past decade. It remains unclear, however, whether concordance with guidelines for FIA management has improved over time. Objective Our objective was to describe changes in emergency department (ED) concordance with guidelines for FIA management. Methods We analyzed data from two multicenter retrospective studies of patients with food-related acute allergic reactions seen in one of 17 EDs during two time periods: 1999-2001 and 2013-2015. Visits were identified similarly across years – e.g., using ICD-9-CM codes 693.1, 995.60, 995.61-995.69, 995.0, and 995.3. Anaphylaxis was defined as an acute allergic reaction with involvement of 2+organ systems or hypotension. We compared concordance between time periods for four guideline recommendations: 1) treatment with epinephrine, 2) discharge prescription for epinephrine auto-injector (EAI), 3) referral to an allergist/immunologist, and 4) instructions to avoid offending allergen. Results We compared 290 FIA patients during 1999-2001 and 459 during 2013-2015. Any treatment with epinephrine (pre-ED or in the ED) for patients with FIA increased over time (38% vs. 56%; P Conclusion Over the nearly 15-year study interval, we observed clinically and statistically significant increases in ED concordance with epinephrine-related guidelines for FIA. Management gaps remain and interventions to standardize care still appear warranted.