Anaphylaxis remains difficult to diagnose and epinephrine underused.
We conducted an anonymous online survey of pediatricians to better understand their thoughts regarding when acute allergic reactions constitute anaphylaxis and when epinephrine should be given.
The survey consisted of 8 case-based scenarios of allergic reactions with two questions about each case: 1) Does this case represent anaphylaxis? and 2) If this patient immediately presented to you, would you treat the patient with epinephrine during the reaction?
A total of 1001 responses were analyzed. When assessing all cases combined, there was discordance in whether a case represented anaphylaxis and administration of epinephrine was warranted in 8% of cases. An average of 5% of all respondents suggested that the case represented anaphylaxis but would not warrant epinephrine, while an average of 3% suggested that the case did not represent anaphylaxis, but that epinephrine was warranted.
Results of this survey show that there is discordance among pediatricians of when allergic reaction is considered anaphylaxis, as well as a discordance of when epinephrine is warranted. These data highlight the need for continued improvement of the definition of anaphylaxis and continued need for education regarding diagnosis and management of anaphylaxis.

Copyright © 2020. Published by Elsevier Inc.