mast cells are the key effector cell of the biological response to anaphylaxis with the release of various mediators of inflammation .
the frequency of anaphylaxis is approximately 502000 episodes/100,000 persons and has a lifetime prevalence of 0.052.0% .
recent studies have shown that there is an increase in incidence and prevalence of anaphylaxis over the last 20 years .
adrenaline is the life saving and first line of drug to be used for the treatment of anaphylaxis .
several studies conducted previously reveals that there is a lack of knowledge regarding dose and route of administration of adrenaline and confusion in selecting the first line drug for treating the emergency condition among health care professionals .
the aims and objectives of this study were to assess the knowledge of interns , medical students , and nursing students regarding anaphylaxis and to ascertain the knowledge regarding dose , route of administration , and concentration of the drug(s ) used for its management .
this cross - sectional study was conducted in a tertiary care teaching hospital after obtaining permission from the institutional ethical committee . health care providers ( interns , final year nursing students and mbbs phase - ii )
a questionnaire was developed comprised of ten questions , regarding knowledge about anaphylaxis and the drugs used in its management ( appendix 1 ) .
knowledge regarding anaphylaxis was ascertained based on the number of questions each participant answered correctly .
the response to the individual questions for the subjects in each group was analyzed separately .
descriptive statistics was analyzed using epi - data analysis version v2.2.2.178 software ( epidata association from denmark ) .
the results were analyzed using the chi - square test , and p < 0.05 was considered as statistically significant .
a total of 265 subjects participated in this study , of which 99 were 2 year medical students , 101 medical interns , and 65 were nursing students .
of 265 subjects , 175 answered correctly the first question ( # 1 ) regarding to which type of hypersensitivity reaction anaphylaxis belongs .
one hundred and fifty - one ( 56.9% ) subjects answered correctly the second question ( # 2 ) , indicating that they would select adrenaline as the first line of drug for anaphylaxis . among 151 subjects 40 ( 26.4% ) answered the correct dose of adrenaline of which 25 ( 16.5% ) of subjects selected that the preferred method of administration was intramuscular injection [ figure 1 ] , 14 ( 9.2% ) selected subcutaneous injection , only eight ( 5.2% ) selected intravenous injection .
total percentage of correct response for each question the response to the first two questions ( # 1 , 2 ) was almost similar ( 65% , 69% ) among interns and mbbs - ii students , respectively , when compared to the nursing students ( 37% ) . for the next three questions ( # 3 , 4 , 5 ) regarding the dose , route and site of administration , medical students had better knowledge ( 27% , 47% , and 40% ) than interns ( 16% , 19% , and 17% ) and nursing students ( 11% , 18% , and 6% ) respectively .
the responses to the questions ( # 6 , 7 , 8) related to the concentration of adrenaline for the intravenous , intramuscular and subcutaneous route , were answered incorrectly by all three groups [ figure 2 ] .
percentage of correct response in each group there was a statistical significant difference between medical students , interns and nursing students in response to questions ( # 2 , 4 , 5 ) related to the first drug of choice , the route , and the site of administration of drug ( p < 0.001 ) for the treatment of anaphylaxis , showing that medical students had more knowledge in these areas [ table 1 ] .
anaphylaxis , an acute life - threatening emergency condition , requires immediate treatment in order to prevent further progression and to prevent complications .
the main purpose of this study was to assess the existing knowledge of interns , nursing students , and mbbs phase ii students regarding anaphylaxis and its medical management .
it was observed that none of the subjects answered all the questions correctly . when the response to the individual questions were analyzed , 65.6% of subjects answered correctly to the question related to anaphylaxis ( i.e. , question numbers 1 and 2 ) and the response rate was poor in areas related to the medical management of anaphylaxis .
previous studies have shown that 90.1% of medical professionals prefer adrenaline as the first line drug , with 38.3% preferring intramuscular route and 51.7% preferring intravenous adrenaline .
our study has shown that the majority of subjects ( 56.9% ) preferred adrenaline as the first line drug for the treatment of anaphylaxis .
of 151 subjects , 16.5% preferred intramuscular injection as the most appropriate route of administration .
this shows that the level of knowledge in our study was lower when compared to previous study . among the study subjects ,
medical students had better knowledge of anaphylaxis as regards the type of hypersensitivity reaction and as to which drug is used for first line treatment .
another study has shown that 80 ( 73.3% ) of participants correctly opted to use adrenaline as first - line treatment for anaphylaxis . in that study ,
, our study revealed that 67 ( 67.6% ) medical students , 61 ( 60.3% ) of interns and 23 ( 35.3% ) of nursing students chose adrenaline ( p < 0.001 ) .
in one prior study , the reason for not choosing adrenaline as first line drug by junior doctors was probably due to their concern with its potential adverse effect .
another study comparing two district hospitals has shown that there was a lack of knowledge in a significant number of senior and junior doctors regarding the dose , route , and concentration of adrenaline .
our study also showed similar results . in our study , of the 151 subjects who had answered adrenaline as the first line drug , only 40 knew the correct dose of adrenaline , out of which 25 subjects selected intramuscular injection as the preferred route of administration .
the standard pediatric dose is 0.01 mg / kg , but the majority of the participants were unable to answer the correct dose .
there was a lack of knowledge about the pediatric dose , the route and the concentration of adrenaline .
the main limitation of our study was that it was a single - centered study with a small sample size and included only interns , medical , and nursing students .
there is a need for the development of interventional strategies to fill the knowledge gap for the ideal anaphylaxis management .
knowledge regarding anaphylaxis and its management is a basic requirement that every health care providers must acquire for the appropriate treatment of all patients . in our study , there was a lack of knowledge regarding the medical management of anaphylaxis in interns , mbbs phase ii students , and nursing students .
proper initial training and periodic review and reinforcement of the steps in the treatment of anaphylaxis is necessary for all health care providers to achieve better patient care .
 objectives : this study was conducted to assess the level of knowledge of health care providers regarding anaphylaxis and its management at a tertiary care teaching hospital.materials and methods : a pretested structured questionnaire was administered to interns , mbbs phase ii students , and nursing students . 
 the subjects were asked to answer the questionnaire , which included questions regarding anaphylaxis and its management.results:of 265 subjects , 151 ( 56.9% ) of subjects answered correctly that adrenaline is the first line of drug for the treatment of anaphylaxis . among 151 subjects , 40 ( 26.4% ) answered the correct dose of adrenaline , of which 25 ( 16.5% ) subjects selected intramuscular injection as the most appropriate route of administration . 
 medical students ' performance was better than interns and nursing students on questions regarding dose , route , and site of adrenaline administration.conclusion:knowledge regarding the management of anaphylaxis was inadequate in almost all the health care providers who were included in the study . 
 improved education and training of health care providers are necessary for better management of anaphylaxis . 
Introduction
Materials and Methods
Results
Discussion
Conclusion
None
Financial support and sponsorship
Conflicts of interest