Persistent Confusion on Managing Severe Allergic Reactions Reveals Gaps in Patient and EMS Protocols

Despite the potentially life-threatening nature of anaphylaxis, recent studies reveal that patients and emergency medical services (EMS) across the United States struggle with inconsistent guidelines and limited knowledge on effective management. Two studies, presented at the American College of Allergy, Asthma, and Immunology (ACAAI) conference, shed light on the hesitations patients experience in using epinephrine and the varied EMS protocols across states, underscoring the need for clearer, standardized approaches.

Hesitation to Use Epinephrine: A Critical Barrier for Patients

The first study, led by Dr. Sasha Alvarado from Baylor College of Medicine, surveyed 96 patients and caregivers in an allergy clinic, revealing considerable uncertainty about recognizing and responding to anaphylaxis. Although 95% of surveyed individuals had access to epinephrine, only 14% reported that they would use it as a first-line response during an anaphylactic episode. Primary reasons for hesitation included uncertainty about which symptoms warranted treatment, fear of going to the emergency room, and lack of confidence in using auto-injectors. Surprisingly, over 40% were unsure about which symptoms necessitated epinephrine use, and nearly 18% were hesitant to call emergency services.

Dr. Alvarado emphasized the importance of patient education, noting that prompt recognition of anaphylaxis symptoms and the immediate use of epinephrine are crucial for favorable outcomes. However, the study findings suggest a significant need for improved educational resources to help patients and caregivers recognize anaphylaxis early and act swiftly with the correct treatment.

Inconsistent EMS Protocols Complicate Anaphylaxis Care

In a parallel study, Dr. Carly Gunderson from Memorial Healthcare System in Fort Lauderdale examined EMS protocols across 30 states and found considerable discrepancies in how anaphylaxis is defined and treated. The study revealed that only half of the states included gastrointestinal symptoms in their definitions, and less than half considered neurological symptoms—both common indicators of anaphylaxis. Furthermore, although nearly all states recommended epinephrine as the primary treatment, only 57% provided auto-injectors to EMS teams.

The study also found that many protocols relied on outdated treatment recommendations, such as using steroids, despite limited evidence supporting their immediate effectiveness in anaphylactic emergencies. In addition, while most states recommended using albuterol for respiratory symptoms, there was considerable variation in the use of intravenous fluids and other supportive measures. These inconsistencies may lead to delayed or suboptimal care, depending on location, and underscore the urgent need for standardized, evidence-based protocols across EMS systems.

Why Streamlined Protocols Matter

The findings from these studies highlight a critical gap in both patient and EMS readiness to handle anaphylaxis—a condition that requires rapid and decisive action to prevent life-threatening complications. For patients, education on recognizing symptoms and confidence in using epinephrine can make a vital difference in outcomes. Given that hesitation or uncertainty can delay treatment, clear action plans and accessible training on auto-injector use are essential for empowering patients and caregivers to act promptly.

For EMS providers, standardized definitions and treatment guidelines across states could eliminate confusion and improve response times. Anaphylaxis symptoms can escalate within minutes, leaving little room for misinterpretation or variation in care protocols. As anaphylaxis cases continue to rise, especially with food allergies, creating uniform guidelines for EMS teams could significantly enhance patient survival and reduce morbidity.

In sum, these studies underscore the need for unified guidelines and education initiatives at both the patient and provider levels to ensure timely, effective responses to anaphylactic emergencies.