To describe emergency department management of acute urticaria
in children and to determine factors associated with management strategies and adherence to practice guidelines
Self-administered cross-sectional survey mailed to all Section of Emergency Medicine members of the American Academy of Pediatrics (n = 1190) and 1000 randomly selected members of the American College of Emergency Physicians. Main outcome measure was proportion of respondents adhering to published guidelines
. Factors associated with management strategies were analyzed using bivariate and logistic regression analyses.
Of 2190 surveys sent, 1137 (52.5%) were available for analysis. Respondents included 44.6% pediatric emergency physicians, 36.4% emergency physicians, and 15.3% pediatricians. First-generation histamine (H)1
antagonists alone were the most common therapy used on initial presentation of acute urticaria
, followed by corticosteroids
antagonists, and second-generation H1
antagonists, used by only 7.8%, despite their recommendation as first-line therapy. Physicians working in an emergency department as opposed to an urgent or primary care setting were less likely to use second-generation H1
antagonists (odds ratio [OR], 0.3 [0.1-0.7]). General emergency physicians were 2.6 times more likely to use H2
antagonists and more than 3 times as likely to use corticosteroids
. Only 14.2% of physicians overall were familiar with guideline recommendations.
Minimal awareness and use of existing guidelines
, and low concordance with published recommendations exist. Management practices vary and are influenced by training, practice setting, and clinical experience.