A survey of emergency department management of acute urticaria in children

Objectives: To describe emergency department management of acute urticaria in children and to determine factors associated with management strategies and adherence to practice guidelines. Methods: 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. Results: 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, H-2 antagonists, and second-generation H-1 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 H-1 antagonists (odds ratio [OR], 0.3 [0.1-0.7]). General emergency physicians were 2.6 times more likely to use H-2 antagonists and more than 3 times as likely to use corticosteroids. Only 14.2% of physicians overall were familiar with guideline recommendations. Conclusions: 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.