Knowledge gaps especially apparent for primary care and emergency physicians, often on front line in treatment for anaphylaxis
January 14, 2015, WASHINGTON, DC – (PRNewswire/USNewswire) A novel study by the Asthma and Allergy Foundation of America (AAFA) finds significant differences among physician groups in knowledge and attitudes regarding anaphylaxis. In a Letter to the Editor published last week in the Journal of Allergy and Clinical Immunology (JACI), the authors of the study summarized results from the physician survey, which revealed startling deficiencies among physician groups.
The letter, Anaphylaxis in America: A national physician survey, based on AAFA’s study of the same name, provides an in-depth look at the experience with and knowledge of anaphylaxis among 5 physician groups: allergy/immunology specialists (50% with pediatric and 50% with internal medicine training), emergency physicians, family practitioners, and pediatricians. It also provides insights into physicians’ awareness and attitudes regarding anaphylaxis. For the full text of the letter, visit www.aafa.org/AnaphylaxisInAmerica.
The physician survey, conducted as part of a larger study including patient and public surveys, was led by Dr. Robert Wood, chair of the AAFA research panel and Director of Allergy and Immunology at Johns Hopkins Children’s Center. “Similar to our surveys of patients and the general public, this study clearly demonstrates the need for ongoing education regarding anaphylaxis,” according to the letter.
“One of the most alarming things we found is that, despite the common occurrence of anaphylaxis, too many physicians are unfamiliar with the professional guidelines for anaphylaxis,” says Mike Tringale, Senior Vice President at AAFA and one of the authors of the letter. “It is critical for physicians across all these groups to prescribe and use life-saving emergency medication when necessary.”
Apparent Knowledge Gaps
Anaphylaxis is a sudden, life-threatening allergic reaction with various triggers, presentations, and severities. Epinephrine is indicated as the first-line treatment for anaphylaxis, and must be administered promptly at the first sign of a severe allergic reaction. According to AAFA’s recent national study, the estimated lifetime prevalence of anaphylaxis in the general population is 1.6% to 5.1%, making it a common condition that most physicians are likely to encounter. Despite this, the recent physician survey portion of the study revealed potential deficiencies and knowledge gaps among primary care physicians, emergency physicians, and even allergy/immunology specialists.
Although most physicians reported being very familiar with the term anaphylaxis (range, 89% to 100% across the 5 physician groups) and recognize that epinephrine is the recommended first-line treatment (81% to 93%), it is concerning that many physicians did not recognize some of the most common anaphylaxis symptoms, such as breathing problems, fainting, swelling and abdominal pain. When asked about possible symptoms of anaphylaxis, there were significant differences among the groups regarding cough (30% to 55%), skin reactions (26% to 54%) and abdominal pain (6% to 46%) as possible indicators.
When asked about possible food triggers of anaphylaxis, physicians responded consistently identifying peanut (70% to 95%) as a common trigger, but differently in identifying tree nuts (30% to 72%), milk (6% to 47%) and eggs (9% to 57%) as foods likely to cause a severe allergic reaction.
The survey also revealed a number of alarming findings regarding physicians’ perceptions of day-to-day issues for patients at-risk for anaphylaxis. Many physicians were misinformed about the availability of epinephrine; 19% to 33% of the physicians mistakenly reported that restaurants are required to have epinephrine auto-injectors available and 77% to 94% wrongly indicated that all ambulances are required to carry epinephrine. When questioned regarding quality of life, only 10% of family practitioners and 31% of pediatricians believed that “severe allergies” have a major impact on quality of life.
“It’s concerning to see how much physicians’ perception of quality of life for anaphylaxis patients differs from the patients’ perception,” says Lynda Mitchell, Vice President at AAFA and Founder of Kids With Food Allergies (KFA), a division of AAFA. “We need to work even harder to ensure that physicians across these practices are better prepared to treat and care for patients at-risk for anaphylaxis.”
Need for Education
Given that anaphylaxis is common and potentially fatal, the findings from the survey raise significant concern about overall physician knowledge of this condition. The survey found that many physicians did not identify all potential symptoms of anaphylaxis. Despite larger knowledge gaps among emergency and primary care physicians, very few advise subspecialty referral for patients with anaphylaxis. Also concerning is that many physicians responded that there are risks associated with the use of epinephrine, although most experts agree that this is not the case for patients presenting with anaphylaxis. These issues raise concern that physicians may be less likely to both prescribe and use epinephrine in practice than they reported in the survey.
The study, and particularly the physician survey portion, demonstrates a need to not only educate patients and the public, but also the professionals who care for patients at-risk for anaphylaxis. Knowledge gaps regarding anaphylaxis are especially apparent for primary care and emergency physicians, who are most often the physicians on the front line in the treatment of this common and life-threatening condition.
About the Study
Anaphylaxis in America is an independent research project of AAFA sponsored by Sanofi US. The study was designed by AAFA along with a leading group of health, medical and research experts to assess prevalence, as well as to better understand patient, public and physician attitudes and behaviors regarding anaphylaxis. Three independent nationwide, cross-sectional random-digit-dial (RDD) landline telephone surveys were conducted by the survey research firm Abt SRBI – a public survey, a patient survey and a physician survey. The study began in 2011 and was completed in 2012.
The physician interviews comprised of allergy/immunology specialists (50% with pediatric and 50% with internal medicine training), emergency physicians, family practitioners, and pediatricians. Four thousand advance letters were sent to a sample derived randomly from the American Medical Association/American Osteopathic Association, from which 330 were screened and 318 interviewed. The final cohort included 114 allergy/immunology specialists, 102 emergency physicians, 50 family practitioners, and 50 pediatricians. The interview consisted of 47 questions and lasted on average 19.1 minutes.
The Asthma and Allergy Foundation of America (AAFA), a not-for-profit organization founded in 1953, is the leading patient organization for people with asthma, allergies and related conditions. AAFA provides practical information, community based services and support through a national network of chapters and support groups. AAFA develops health education, organizes state and national advocacy efforts and funds research to find better treatments and cures. Learn more about AAFA and the study at www.aafa.org/AnaphylaxisInAmerica.
EDITOR’S NOTE: Please see the letter for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. The Journal of Allergy and Clinical Immunology (JACI), an official scientific journal of the American Academy of Allergy, Asthma & Immunology (AAAAI), is the most-cited journal in the field of allergy and clinical immunology.
CONTACT FOR MEDIA ONLY: Sanaz Eftekhari, AAFA External Affairs, firstname.lastname@example.org, 202-466-7643, x238.
SOURCE: Asthma and Allergy Foundation of America (AAFA)