Management of acute food allergic reactions by general practitioners

R.J.B. Klemans, T.M. Le, V. Sigurdsson, C.F. Enters-Weijnen, E. van Hoffen, C.A.F.M. Bruijnzeel-Koomen, A.C. Knulst

Background: Food is one of the leading causes of anaphylaxis. In the Netherlands, patients visit a general practitioner (GP) as often as an emergency department (ED) in case of an acute food allergic reaction. So far, the management of food allergic reactions by GPs has not been investigated. Therefore, we explored the management of acute food allergic reactions by GPs regarding specific treatment, observation period, prescription of emergency medication to treat new episodes, diet advices and referral to a specialist. Methods: A questionnaire containing three hypothetical cases (two anaphylactic and one mild case) with questions about their management was sent to 571 GPs. Results: Overall, treatment choice was dependent on the severity of the reaction (mild vs. anaphylaxis, P < .001). However, epinephrine was used for treatment of anaphylaxis with mainly respiratory symptoms in only 27% and for anaphylaxis with mainly cardiovascular symptoms in 73%. At discharge, the percentages for prescription of self-injectable epinephrine were 53% and 77%, respectively. A short observation period of <2 hours was advised by 42% of general practitioners in case of anaphylaxis.
Conclusions: Treatment of food induced anaphylaxis by GPs appears to be suboptimal: a considerable number of patients would not be treated with epinephrine for the acute reaction (especially anaphylactic cases with respiratory symptoms), the observation period chosen by GPs was often too short and self-injectable epinephrine was not always prescribed at discharge to treat possible new episodes. Education programs are needed to increase the awareness of GPs to recognize and treat anaphylactic reactions.

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