BACKGROUND: In the Emergency Department (ED), diagnosis and management of anaphylaxis are challenging with at least 50% of anaphylaxis episodes misdiagnosed when the diagnostic criteria of current guidelines are not used.OBJECTIVE: Objective of our study was to assess anaphylaxis diagnosis and management in patients presenting to the ED.METHODS: Retrospective chart review conducted on patients presenting to The Medical City Hospital ED, the Philippines from 2013–2015 was done. Cases were identified based on International Statistical Classification of Diseases, 10th revision coding for either anaphylaxis or other allergic related diagnosis. Cases fitting the definition of anaphylaxis as identified by the National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network (NIAID/FAAN) were included. Data collected included demographics, signs and symptoms, triggers and management.RESULTS: A total of 105 cases were evaluated. Incidence of anaphylaxis for the 3-year study period was 0.03%. Of the 105 cases, 35 (33%) were diagnosed as “urticaria” or “hypersensitivity reaction” despite fulfilling the NIAID/FAAN anaphylaxis criteria. There was a significant difference in epinephrine administration between those given the diagnosis of anaphylaxis versus misdiagnosed cases (61 [87%] vs. 12 [34%], χ² = 30.77, p < 0.01); and a significant difference in time interval from arrival at the ED to epinephrine administration, with those diagnosed as anaphylaxis (48%) receiving epinephrine within 10 minutes, versus ≥ 60 minutes for most of the misdiagnosed group (χ² = 52.97, p < 0.01).CONCLUSION: Despite current guidelines, anaphylaxis is still misdiagnosed in the ED. Having an ED diagnosis of anaphylaxis significantly increases the likelihood of epinephrine administration, and at a shorter time interval.
Anaphylaxis ; Classification ; Clinical Coding ; Communicable Diseases ; Demography ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Epinephrine ; Food Hypersensitivity ; Hospitals, Urban ; Humans ; Hypersensitivity ; Incidence ; Philippines ; Retrospective Studies ; Tertiary Care Centers

Diarrhea has been the subject of considerable attention and effort. A variety of anti-secretory agents have been subjected to countless investigations including racecadotril as an adjunct therapy. Objectives: To assess the effectiveness of racecadotril, along with oral rehydration solution, in the treatment of diarrhea. Methods: The Cochrane Library and Pubmed were searched for trials; high sensitive search terms were used including "randomized controlled trials", "racecadotril" and "diarrhea". Outcome measures were stool output, duration of diarrhea, and number of bowel movements. Data Collection and Analysis: Three reviewers assessed the methodological quality. Analysis was implemented with Review Manager 5 using standard mean difference as treatment measure. Results: The search yielded 21 results; four of which fulfilled selection criteria. A total of 659 participants were given 1.5mg/kg of racecadotril. The meta-analysis showed that racecadotril is effective in reducing stool output in 48 hours compared to the control group. This finding was congruent for those positive for rotavirus and for the duration of the diarrhea. There were lesser children who revisited their doctors after 48 hours of treatment. The chance of cure after day seven of treatment was higher in the racecadotril group when compared to the control group. Racecadotril with ORS was comparable to ORS alone in terms of safety and tolerability. Conclusion: There is evidence that the drug racecadotril holds promise in terms of reducing stool output, number of bowel movements and duration of diarrhea. However, well-designed randomized control trails with an adequate sample size and absence of any competitive interest in studying the efficacy and safety of racecadotril in acute diarrhea are needed before we reach any conclusion regarding the role of the drug in diarrhea.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; DIARRHEA ; RACECADOTRIL