Appropriateness of epinephrine use in ED patients with anaphylaxis.

Background: Studies have demonstrated low rates of emergency department (ED) epinephrine administration for anaphylaxis patients, suggestive of ED undertreatment of anaphylaxis. Our study assessed the appropriateness of ED epinephrine administration in anaphylaxis management.

Methods: A prospective observational study was conducted involving ED patients presenting with possible allergic reactions.

Predictors of Repeat Epinephrine Administration for Emergency Department Patients with Anaphylaxis.

Background: Risk factors that predict which patients with anaphylaxis might require repeat doses of epinephrine are poorly understood.

Objective: The objective of this study was to identify risk factors associated with the need for multiple doses of epinephrine during an anaphylactic reaction.

Methods: Patients were included if they met diagnostic criteria for anaphylaxis on presentation to the emergency department (ED) at our academic medical center between April 2008 and February 2014.

Burden of chronic obstructive pulmonary disease: healthcare costs and beyond.

Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating respiratory condition that leads to significant burden, both medically and financially. It affects millions of people worldwide and causes significant morbidity and mortality. Most detailed information related to its prevalence, morbidity, and mortality comes from high-income countries, but 90% of COPD-related deaths occur in low- and middle-income countries.

A multifaceted intervention for patients with anaphylaxis increases epinephrine use in adult emergency department.

Background: Studies have documented inconsistent emergency anaphylaxis care and low compliance with published guidelines.

Objective: To evaluate anaphylaxis management before and after implementation of an emergency department (ED) anaphylaxis order set and introduction of epinephrine autoinjectors, and to measure the effect on anaphylaxis guideline adherence.

Methods: A cohort study was conducted from April 29, 2008, to August 9, 2012.

Successful outpatient graded administration of trimethoprim-sulfamethoxazole in patients without HIV and with a history of sulfonamide adverse drug reaction.

Background: The outcomes of trimethoprim-sulfamethoxazole (TMP-SMX) desensitization have been widely reported in the HIV literature but less so in the non-HIV literature.

Objective: To evaluate the safety and efficacy of graded administration of TMP-SMX in patients without HIV and with a history of TMP-SMX adverse drug reaction (ADR).

Methods: A retrospective chart review, 2004-2012, of all the patients without HIV seen in the Division of Allergic Diseases and with a history of TMP-SMX ADR who underwent outpatient graded administration of TMP-SMX was conducted.

Anaphylaxis: diagnostic criteria and epidemiology.

Evaluation of anaphylaxis is a common reason for emergency department referral to an allergist. Establishing unified diagnostic criteria has been an evolving process with the most recent definition proposed by the Second Symposium on the Definition and Management of Anaphylaxis convened by the National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network. Proper identification of these patients in the emergency department allows for the opportunity to dispense potentially life-saving epinephrine autoinjectors, provide education, and allergist referral.

Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis.

Background: Risk factors for increased anaphylaxis severity are poorly understood. Angiotensin-converting enzyme (ACE) inhibitors have been associated with severe anaphylactic reactions in patients with hymenoptera venom allergy. Studies evaluating the association between beta-blockers and severe anaphylaxis have been conflicting.

Evaluation of national institute of allergy and infectious diseases/food allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients.

Background: Diagnostic criteria were proposed at the Second Symposium on the Definition and Management of Anaphylaxis convened by the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN). Validation is needed before these criteria can be widely adapted into clinical practice.

Objective: Our aim was to retrospectively assess the diagnostic accuracy of the NIAID/FAAN criteria for the diagnosis of anaphylaxis in emergency department (ED) patients.

Anaphylaxis in emergency department patients 50 or 65 years or older.

Background: Anaphylaxis is a potentially life-threatening allergic reaction commonly managed in the emergency department (ED). Data describing patients 50 or 65 years or older with anaphylaxis are limited.

Objective: To describe the presentation and management of patients with anaphylaxis who were 50 or 65 years or older and to compare these findings with those of younger patients.

How well does patient self-report predict asthma medication possession? Implications for medication reconciliation and adherence assessment.

Background: Self-report is the most commonly used method for collecting information regarding asthma medication possession and adherence in clinical practice.

Objective: To determine the agreement between self-report and pharmacy claims data for asthma medication possession.

Methods: This is a retrospective study that examined pharmacy claims data 12 months before and after participants completed a structured asthma survey.

Factors associated with repeated use of epinephrine for the treatment of anaphylaxis.

Background: Studies looking at the use of repeated doses of epinephrine in patients experiencing anaphylaxis are limited.

Objective: To determine which patients are most likely to receive repeated doses of epinephrine during anaphylaxis management.

Methods: A population-based study with medical record review was conducted.

Visual representation of National Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network criteria for anaphylaxis.

We present a user-friendly visual representation of The National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network criteria so as to enhance recognition of anaphylaxis and active teaching and learning.

The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project.

Background: Reported incidences of anaphylaxis range from 3.2 to 20 per 100,000 population. The incidence and trend over time has meaningful public health implications but has not been well characterized because of a lack of a standard definition and deficiencies in reporting of events.

Formulating an effective and efficient written asthma action plan.

Written asthma action plans (WAAPs) are recommended by national and international guidelines to help patients recognize and manage asthma exacerbations. Despite this recommendation, many patients with asthma do not have a WAAP. In addition, WAAPs vary widely in their readability and usability.

The ABCs of asthma control.

The new asthma guidelines have introduced impairment and risk assessments into the management of asthma. Impairment assessment is based on symptom frequency and pulmonary function, whereas risk assessment is based on exacerbation frequency and severity. These 2 measures determine the initial severity of asthma in the untreated patient as well as the degree of control in asthma once treatment has been initiated.

Allergen immunotherapy.

Allergen immunotherapy involves exposing a patient to a gradually escalating dose of a specific allergen with the intention of decreasing allergic and inflammatory responses, ultimately leading to a sustained decrease in allergic symptoms. A build-up phase (once weekly injections) is followed by a maintenance phase (once monthly injections) that generally continues for 3 to 5 years. Allergen immunotherapy is indicated for select patients with allergic rhinoconjunctivitis, allergic asthma, and stinging insect hypersensitivity.

Female sex as a risk factor for penicillin allergy.

Background: Identification of risk factors is an integral part of a physician's evaluation of a patient.

Objective: To determine whether female sex is an independent risk factor for penicillin allergy.

Methods: Rates of positive penicillin skin test (PST) results, according to sex, were determined in patients with a history of penicillin allergy undergoing penicillin allergy evaluation with major and minor determinants of penicillin between June 1, 2002, and June 30, 2004.

Asthma treatment in a population-based cohort: putting step-up and step-down treatment changes in context.

Objective: To assess the frequency and types of visits related to modifications in the intensity of asthma medications.

Patients And Methods: We retrospectively reviewed the medical records of adults (aged 18-40 years) and children (aged 6-17 years) living in Olmsted County, Minnesota, to evaluate changes in asthma medications by dose and drug class and site and type of visit (routine vs unscheduled) at the time of changes. All records from all visits were reviewed for each patient to identify asthma-related visits at all sites of care from January 1, 2002, through December 31, 2003.

Safety and effectiveness of a preoperative allergy clinic in decreasing vancomycin use in patients with a history of penicillin allergy.

Background: We developed a clinical pathway to optimize the use of antimicrobials by decreasing vancomycin use in preoperative patients with a history of penicillin allergy.

Objective: To decrease the use of vancomycin in surgical patients with a self-reported penicillin allergy.

Methods: In June 2002, same-day allergy consultation and penicillin skin testing were made available for preoperative patients with self-reported penicillin allergy at the preoperative evaluation (POE) clinic.

Views of new internal medicine faculty of their preparedness and competence in physician-patient communication.

Background: We sought to assess self-rated importance of the medical interview to clinical practice and competence in physician-patient communication among new internal medicine faculty at an academic medical center.

Methods: Since 2001, new internal medicine faculty at the Mayo Clinic College of Medicine (Rochester, Minnesota) have completed a survey on physician-patient communication. The survey asks the new faculty to rate their overall competence in medical interviewing, the importance of the medical interview to their practice, their confidence and adequacy of previous training in handling eight frequently encountered challenging communication scenarios, and whether they would benefit from additional communication training.