Knowledge and Attitudes of Family Physicians Regarding Pediatric Anaphylaxis

Knowledge and Attitudes of Family Physicians Regarding Pediatric Anaphylaxis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge and Attitudes of Family Physicians Regarding Pediatric Anaphylaxis Hilal Özkaya, Sibel Baktır Altuntaş, Nevin Kurt, Erdoğan Eriş This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8080439/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background Anaphylaxis is an acute-onset, life-threatening systemic hypersensitivity reaction. Pediatric anaphylaxis (PA) is important in family health centers (FHC) due to pediatric vaccination and some treatment practices. The aim of this study was to analyze the knowledge and attitudes of family physicians regardingPA. Methods This study is a cross-sectional, survey study. The study included 321 family physicians between the ages of 24 and 65 who were actively working in FHC within the borders of Istanbul and agreed to participate in the study. The survey consisted of three sections: the first section included the family physicians’ personal and professional characteristics; the second section comprised a knowledge questionnaire designed to measure the physicians’ level of knowledge about PA; and the third section assessed the situation regarding PA in FHC. Results In this study, the mean age of the 321 participating family physicians was 38.15 ± 9.36 years; 57.3% were female, and 41.7% had between 6–15 years of professional experience. Among the participants, 47% had received training on PA, 13.1% had encountered a PA case at FHC, adrenaline was available in 97.8% of the centers, and 60.1% reported having an anaphylaxis emergency action plan in their facility. The mean score of the participants on the anaphylaxis knowledge questionnaire was 20.91 ± 5.13 (min:8, max:29) point. Participants aged 40 years or younger scored significantly higher on the anaphylaxis knowledge questionnaire compared to those over 40 years of age (p = 0.006). Similarly, those who had received training on PA (p < 0.001), those who had encountered a PA case (p = 0.021), those whose FHC had adrenaline available (p = 0.018), and those with an anaphylaxis emergency action plan in FHC (p = 0.032) also demonstrated significantly higher knowledge scores. Conclusions In this study conducted with family physicians in Istanbul, it was found that their level of knowledge regarding pediatric anaphylaxis was high. Due to the vaccination practices in pediatric age groups, physicians’ awareness and knowledge in this area are of critical importance. Therefore, it is essential to increase field-based training and scientific research on this topic. Anaphylaxis family practice primary healthcare vaccination BACKGROUND Anaphylaxis is an acute-onset, life-threatening systemic hypersensitivity reaction to an allergen or trigger, typically associated with respiratory or circulatory compromise and exhibiting variable clinical presentations .[ 1 ] The underlying pathophysiology primarily involves the sudden release of mediators from mast cells and basophils. The lifetime prevalence of anaphylaxis is estimated to range from 0.05–2% in the United States and approximately 3% in European countries. [ 2 ] Parallel to the increase in overall allergic diseases in the pediatric population, the number of anaphylaxis cases in children has also been rising. The estimated global prevalence of pediatric anaphylaxis (PA) ranges between 0.04% and 1.8%.[ 3 ] The clinical presentation of anaphylaxis is heterogeneous, affecting the skin, respiratory, gastrointestinal, and cardiovascular systems. In the early stages, prodromal symptoms such as mild itching, burning sensations in the palms, soles, or anogenital region, metallic taste, anxiety, headache, and confusion may occur. [ 4 , 5 ] Typically, symptoms develop within 1–15 minutes after exposure to the allergen, though in rare cases, onset may be delayed beyond 30 minutes. [ 5 ] Although cutaneous findings are observed in 80–90% of cases, anaphylaxis can also occur without skin manifestations, which may complicate diagnosis.[ 6 ] In children, respiratory symptoms are more common, whereas in adults, cardiovascular findings tend to predominate. The signs and symptoms of anaphylaxis are sometimes unpredictable and may vary between patients or even between multiple attacks in the same individual.[ 1 , 3 ] A study conducted in Spain reported that only 53% of children diagnosed with anaphylaxis in the emergency department were correctly identified, and in 39% of cases, the final etiology differed from the initial assumption.[ 7 ] Early recognition and prompt management are essential in the treatment of anaphylaxis. Epinephrine remains the first-line treatment in all age groups.[ 1 , 3 ] Due to the unpredictable course of anaphylaxis, early intramuscular administration of epinephrine is the most critical step in preventing fatal outcomes. Intramuscular injection into the anterolateral thigh should be performed as soon as anaphylaxis is suspected, even if the diagnosis is uncertain, as epinephrine has no absolute contraindication.[ 8 ] Despite the life-saving importance of early diagnosis and treatment, studies have shown varying levels of knowledge and awareness among healthcare professionals regarding anaphylaxis.[ 9 , 10 ] A significant portion of pediatric vaccinations is administered at family health centers (FHCs). Although true allergic reactions to vaccines are rare, reports of possible allergic reactions are relatively frequent. Therefore, it is crucial for family physicians to distinguish genuine allergic reactions from other clinical conditions. However, studies evaluating the knowledge and attitudes of family physicians toward PA remain limited in the literature. The primary aim of this study was to comprehensively assess the level of knowledge of family physicians regarding PA. METHODS Study Design This study was designed as a descriptive and cross-sectional survey. The questionnaire was completed online by physicians between April 1 and July 1, 2022. The questionnaire consisted of three sections: The first section collected personal and professional sociodemographic characteristics of family physicians. The second section consisted of a questionnaire (PA Knowledge Questionnaire) assessing knowledge about anaphylaxis, containing 29 items that were specifically developed for this study and is presented in Table 2. As no validated instrument was available to assess knowledge of PA, the survey was developed based on a comprehensive literature review and the World Allergy Organization (WAO) guidelines.[11] Each correct response was scored as 1 point. The Cronbach’s alpha coefficient for internal consistency was calculated as 0.835, indicating high reliability of the “PA Knowledge Questionnaire”. The third section focused on physicians’ experience with PA cases, including whether they had encountered or treated such cases, and whether they had an emergency action plan for anaphylaxis. Inclusion Criteria The study included family physicians aged 24–65 years who were actively working in Family Health Centers (FHCs) within the boundaries of Istanbul and voluntarily agreed to participate. Physicians who were not actively employed in an FHC in Istanbul or who declined to participate were excluded. Ethical Approval The study was approved by the Clinical Research Ethics Committee of Başakşehir Çam and Sakura City Hospital (Approval No: 2022.03.88, Protocol Code: KAEK/2022.03.88). Sample Size Considering that approximately 5000 family physicians were working in Istanbul at the time, a 95% confidence level and a 5% margin of error were used to determine the required sample size, which was calculated as 321 participants. This sample size was deemed adequate to ensure sufficient statistical power and generalizability of the results. Statistical Analysis All statistical analyses were performed using IBM SPSS Statistics version 25.0. Continuous variables were expressed as mean ± standard deviation (Mean ± SD) and median (IQR), while categorical variables were presented as number (n) and percentage (%). Normality was tested using Skewness and Kurtosis values. The Mann–Whitney U test was used to compare two groups, and the Kruskal–Wallis H test was applied for comparisons involving three or more groups. When a significant difference was detected, Dunn’s post-hoc test was conducted. A p -value of < 0.05 was considered statistically significant. RESULTS A total of 321 family physicians participated in the study. The mean age of participants was 38.15 ± 9.36 years, and 65.7% were aged 40 years or younger. Among them, 57.3% were female, and 41.7% had 6–15 years of professional experience. Approximately 30.8% of participants were specialists in family medicine. Descriptive characteristics of the physicians are presented in Table 1 . Participants demonstrated a high level of knowledge regarding pediatric anaphylaxis. The percentage of correct responses for respiratory symptoms such as dyspnea and stridor was 96.6% , and for uvular and periorbital edema 93.1% . Correct responses for cutaneous symptoms such as urticaria and pruritus were 88.2% . Additionally, 97.8% of participants correctly identified adrenaline as the most effective treatment, and the correct response rate for the adrenaline dosage question was 79.8% (Table 2). Table 3 presents the participants’ mean score on the PA Knowledge Questionnaire. The Cronbach’s alpha coefficient for internal consistency was calculated as 0.835, indicating high reliability of the PA Knowledge Questionnaire. The correlation analyses between selected numerical variables and the PA Knowledge Questionnaire scores are presented in Table 4. Analysis revealed statistically significant relationships between the knowledge scores and several variables, including age, having encountered a pediatric anaphylaxis case, recognition of signs and symptoms, knowledge of adrenaline auto-injectors, availability of adrenaline in the FHC, and the presence of an emergency action plan. Physicians aged ≤ 40 years scored significantly higher than those aged over 40 years (Z = −2.741, p = 0.006). No significant differences were observed in knowledge scores according to gender (p = 0.637) or years of experience (p = 0.108*).Family physicians who had previously received training on pediatric anaphylaxis scored significantly higher than those who had not (Z = −4.193, p < 0.001*). Those who had encountered anaphylaxis cases, knew about AAIs, had adrenaline available, or had an emergency action plan in their FHC also demonstrated significantly higher knowledge levels (p < 0.05*). (Table 5) Participants who had previously received training on pediatric anaphylaxis scored significantly higher than those without such training (Z = −4.193, p < 0.001). Likewise, physicians who reported being knowledgeable about anaphylaxis, who had encountered pediatric anaphylaxis cases, and those who were familiar with AAI demonstrated significantly higher knowledge scores compared with their counterparts (p < 0.05). DISCUSSION In this study, it was observed that family physicians had a high level of knowledge regarding pediatric anaphylaxis (PA). Nearly half of the participants (47%) reported having previously received training on pediatric anaphylaxis, and the vast majority (98.1%) were aware that allergic reactions could be life-threatening. In addition, 86.9% stated that they were knowledgeable about PA in general. The rate of encountering pediatric patients with anaphylaxis in Family Health Centers (FHCs) was 13.1%, and 20.9% of the physicians reported having treated a child with anaphylaxis. These findings highlight the importance of knowledge and preparedness in primary care. In a study conducted in Saudi Arabia, more than 60% of physicians had never treated a patient with anaphylaxis (12), while another study found that 53.7% of physicians had encountered such cases.[13] In the present study, the rate of availability of adrenaline in FHCs was 97.8%, while 60.1% of physicians reported having an anaphylaxis emergency action plan. Although adrenaline is among the essential drugs required to be available in FHCs, an emergency action plan is not mandatory. The mean score on the Pediatric Anaphylaxis Knowledge Questionnaire was 20.91 ± 5.13, indicating that family physicians generally possess a high level of knowledge regarding PA. In a 2012 study conducted by Erkoçoğlu et al., the mean knowledge level of family physicians regarding anaphylaxis was found to be 47.2%.[14] In the present study, the correct response rate for common respiratory symptoms such as dyspnea and stridor was 96.6%, and 93.1% correctly identified uvular and periorbital edema as anaphylactic signs. Similarly, Cambaz Kurt et al. reported a 99% recognition rate among pediatricians for respiratory symptoms of anaphylaxis.[15] Since pediatric vaccinations are routinely administered in FHCs, it is essential for family physicians to have knowledge comparable to that of pediatricians regarding pediatric anaphylaxis. In our study, the rate of recognizing atypical symptoms such as nausea and vomiting was 63%, which is lower than the 86% reported among pediatric emergency physicians.[16] Another study by Pimentel-Hayashi et al. reported lower recognition rates of atypical signs among pediatricians (56.4%) and internal medicine specialists (58.2%), while surgeons showed higher awareness (75%), possibly due to the risk of intraoperative anaphylaxis in anesthesia-related procedures.[17] To our knowledge, there is no previous study evaluating family physicians’ knowledge of atypical symptoms of pediatric anaphylaxis. In the present study, 97.8% of participants correctly identified adrenaline as the most urgent and effective treatment for anaphylaxis. Reported rates in the literature vary across specialties—from 29% to 40.5% among general physicians (18,19), 99.2% among pediatricians (15), and 88.8–93.4% among family physicians.[20] The correct response rate regarding the appropriate dose of adrenaline in pediatric anaphylaxis was 79.8% in our study. Previous studies have reported rates ranging from 16.6% to 59.6%.[11,14,19–21] The higher rate observed in our study suggests an improvement in clinical awareness among family physicians. The rate of correctly identifying the maximum dose of adrenaline was 61.7%, although no comparable data were found in the literature. This finding is clinically relevant since knowledge of repeat dosing may affect patient outcomes. In our study, 81% of participants correctly identified the route of adrenaline administration. In contrast, earlier studies reported lower rates: 34% among pediatricians in 2009 (22), 28.7% among family physicians in 2013 (14), and 49.2% among physicians from mixed specialties.[19] These data suggest that knowledge about adrenaline administration has improved over time. When asked about the side effects of adrenaline, the most frequently recognized symptom was fear or restlessness (75.7%). Although data on this topic are scarce, awareness of potential side effects is important for clinicians administering life-saving treatments. In this study, 88.5% of physicians were aware of AAI, yet only 12% had ever prescribed one. In the United Kingdom, the rate of AAI prescription by family physicians increased by 33% over 12 years.[23] In Turkey, the proportion of physicians familiar with AAIs increased from 17.8% in 2009 to 74.4% in 2023 (11), demonstrating a notable improvement in awareness over time. When knowledge levels were compared by demographics, younger physicians had significantly higher knowledge scores than older ones. This may reflect increased exposure to updated medical education curricula emphasizing anaphylaxis management. Only 47% of participants stated that they had never received formal training on pediatric anaphylaxis. Alghasham et al. (12) found that physicians aged 40 years or older had higher knowledge levels than younger doctors, likely due to accumulated professional experience. No significant differences were found between knowledge levels and gender, years of experience, or specialization. However, physicians who had received training on PA, encountered cases, treated affected children, were familiar with AAIs, or had emergency action plans in their FHCs demonstrated significantly higher knowledge scores. These findings indicate that both exposure to real-life cases and ongoing education are critical factors in enhancing clinical competence. Limitations The main limitation of this study was the absence of a validated and reliable scale to measure physicians’ knowledge of pediatric anaphylaxis. Therefore, a self-developed questionnaire (Pediatric Anaphylaxis Knowledge Questionnaire) with confirmed internal consistency was used. Strengths A key strength of this study is that there are very few studies in the literature evaluating the knowledge and attitudes of family physicians toward pediatric anaphylaxis. Consequently, this research provides valuable baseline data that can guide future studies and educational initiatives. Conclusion This study, conducted among family physicians in Istanbul, found that participants demonstrated a high level of knowledge regarding pediatric anaphylaxis. Considering that routine pediatric vaccinations are administered in FHCs, along with the increasing prevalence of allergic diseases and the existence of atypical presentations of PA, it is of great importance to enhance awareness and knowledge among family physicians. Further field-based training programs and research are recommended to strengthen clinical preparedness and improve patient outcomes in pediatric anaphylaxis. Abbreviations AAI Adrenaline Auto-İnjector FHC Family Health Center PA Pediatric Anaphylaxis Declarations Ethics approval and consent to participate All methods were conducted in accordance with the relevant guidelines and regulations. Informed consent was obtained from all the participants. The study was approved by the Clinical Research Ethics Committee of Başakşehir Çam and Sakura City Hospital (Approval No: 2022.03.88, Protocol Code: KAEK/2022.03.88). The study was conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding There was no funding for the study. Authors’ Contributions HÖ, NK and SBA, conceptualised and designed the study, analysed and interpreted the interview data, and were responsible for drafting and writing the original manuscript. NK and EE conducted the literature review. SBA was involved in the interpretation of the data. HÖ, SBA and NK critically reviewed and edited the manuscript. All the authors have read and approved the final version of the manuscript. Acknowledgements We thank the family physicians for their participation. References Abrams EM, Alqurashi W, Fischer DA, Vander Leek TK, Ellis AK. Anaphylaxis AACI. 2024;20(3):62. Yu JE, Lin RY. The epidemiology of anaphylaxis. Clin Rev Allergy Immunol. 2018;54(3):366–74. Wang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: a systematic review. Allergy. 2019;74(6):1063–80. Cambaz Kurt N. An overview of anaphylaxis in children. Zeynep Kamil Med J. 2021;52(3):116–20. Martelli A, Ippolito R, Votto M, De Filippo M, Brambilla I, Calvani M, et al. What is new in anaphylaxis? Acta Biomed. 2020;91(11–S):e202000. Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026–45. Alvarez-Perea A, Ameiro B, Morales C, Zambrano G, Rodríguez A, Guzmán M, et al. Anaphylaxis in the pediatric emergency department: analysis of 133 cases after an allergy workup. J Allergy Clin Immunol Pract. 2017;5(5):1256–63. Poowuttikul P, Seth D. Anaphylaxis in children and adolescents. Pediatr Clin North Am. 2019;66(5):995–1005. Ribeiro M, Chong Neto HJ, Rosario Filho NA. Diagnosis and treatment of anaphylaxis: there is an urgent needs to implement the use of guidelines. Einstein (Sao Paulo). 2017;15(4):500–6. Mostmans Y, Grosber M, Blykers M, Mols P, Naeije N, Gutermuth J. Adrenaline in anaphylaxis treatment and self-administration: experience from an inner city emergency department. Allergy. 2017;72(3):492–7. Turner PJ, Worm M, Ansotegui IJ, El-Gamal Y, Rivas MF, Fineman S, et al. Time to revisit the definition and clinical criteria for anaphylaxis? World Allergy Organ J. 2019;12(10):100066. Alghasham YA, Alhumaidi KA, Alharbi AM, Alkhalifah YS. Healthcare providers' perception and practice toward anaphylaxis in children in the Qassim Region of Saudi Arabia. Cureus. 2023;15(7):e41366. Alsaleem HN, Almuzaini AS, Aldakheel FN, Almuhaisni R, Alsharekh NA, Alharkan MK, et al. Knowledge and preparedness of physicians in relation to anaphylaxis at primary healthcare centers in Al-Qassim, Saudi Arabia. Cureus. 2024;16(3):e57153. Erkoçoğlu M, Civelek E, Azkur D, Özcan C, Öztürk K, Kaya A, et al. Knowledge and attitudes of primary care physicians regarding food allergy and anaphylaxis in Turkey. Allergol Immunopathol (Madr). 2013;41(5):292–7. Kurt NC, Kutlu NO. Evaluation of pediatricians' awareness about anaphylaxis. Eur Rev Med Pharmacol Sci. 2023;27(5Suppl):53–61. Olabarri M, Gonzalez-Peris S, Vázquez P, González-Posada A, Sanz N, Vinuesa A, et al. Management of anaphylaxis in Spain: pediatric emergency care providers' knowledge. Eur J Emerg Med. 2019;26(3):163–7. Pimentel-Hayashi JA, Navarrete-Rodriguez EM, Moreno-Laflor OI, Del Rio-Navarro BE. Physicians' knowledge regarding epinephrine underuse in anaphylaxis. Asia Pac Allergy. 2020;10(4):e40. Munblit D, Treneva M, Korsunskiy I, Asmanov A, Pampura A, Warner JO. A national survey of Russian physicians' knowledge of diagnosis and management of food-induced anaphylaxis. BMJ Open. 2017;7(7):e015901. El-Sayed ZA, El-Owaidy R, Hussein SM, Hossam D, El-Sawi IH, Adel A, et al. Physicians' knowledge and practice concerning diagnosis and management of anaphylaxis: the situation in Egypt. AfJEM. 2021;11(4):464–70. Özkars MY. Anaphylaxis from the eyes of family physicians. J Curr Pediatr. 2019;17(1):34–44. Arga M, Topal E, Yılmaz S, Erdemli PC, Bıçakcı K, Bakırtaş A. Healthcare workers` knowledge level regarding anaphylaxis and usage of epinephrine auto-injectors. Turk J Pediatr. 2021;63(3):372–83. Cetinkaya F, Zübarioğlu AU, Göktaş S. Pediatricians' knowledge about recent advances in anaphylaxis treatment in Istanbul, Turkey. Turk J Pediatr. 2009;51(1):19–21. Diwakar L, Cummins C, Ryan R, Marshall T, Roberts T. Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study. Br J Gen Pract. 2017;67(657):e300–5. Tables Tables 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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reaction to an allergen or trigger, typically associated with respiratory or circulatory compromise and exhibiting variable clinical presentations .[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] The underlying pathophysiology primarily involves the sudden release of mediators from mast cells and basophils. The lifetime prevalence of anaphylaxis is estimated to range from 0.05\u0026ndash;2% in the United States and approximately 3% in European countries. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eParallel to the increase in overall allergic diseases in the pediatric population, the number of anaphylaxis cases in children has also been rising. The estimated global prevalence of pediatric anaphylaxis (PA) ranges between 0.04% and 1.8%.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe clinical presentation of anaphylaxis is heterogeneous, affecting the skin, respiratory, gastrointestinal, and cardiovascular systems. In the early stages, prodromal symptoms such as mild itching, burning sensations in the palms, soles, or anogenital region, metallic taste, anxiety, headache, and confusion may occur. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Typically, symptoms develop within 1\u0026ndash;15 minutes after exposure to the allergen, though in rare cases, onset may be delayed beyond 30 minutes. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eAlthough cutaneous findings are observed in 80\u0026ndash;90% of cases, anaphylaxis can also occur without skin manifestations, which may complicate diagnosis.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] In children, respiratory symptoms are more common, whereas in adults, cardiovascular findings tend to predominate. The signs and symptoms of anaphylaxis are sometimes unpredictable and may vary between patients or even between multiple attacks in the same individual.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] A study conducted in Spain reported that only 53% of children diagnosed with anaphylaxis in the emergency department were correctly identified, and in 39% of cases, the final etiology differed from the initial assumption.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eEarly recognition and prompt management are essential in the treatment of anaphylaxis. Epinephrine remains the first-line treatment in all age groups.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Due to the unpredictable course of anaphylaxis, early intramuscular administration of epinephrine is the most critical step in preventing fatal outcomes. Intramuscular injection into the anterolateral thigh should be performed as soon as anaphylaxis is suspected, even if the diagnosis is uncertain, as epinephrine has no absolute contraindication.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eDespite the life-saving importance of early diagnosis and treatment, studies have shown varying levels of knowledge and awareness among healthcare professionals regarding anaphylaxis.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] A significant portion of pediatric vaccinations is administered at family health centers (FHCs). Although true allergic reactions to vaccines are rare, reports of possible allergic reactions are relatively frequent. Therefore, it is crucial for family physicians to distinguish genuine allergic reactions from other clinical conditions. However, studies evaluating the knowledge and attitudes of family physicians toward PA remain limited in the literature.\u003c/p\u003e\u003cp\u003eThe primary aim of this study was to comprehensively assess the level of knowledge of family physicians regarding PA.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was designed as a descriptive and cross-sectional survey. The questionnaire was completed online by physicians between April 1 and July 1, 2022.\u003c/p\u003e\n\u003cp\u003eThe questionnaire consisted of three sections:\u003c/p\u003e\n\u003cp\u003eThe first section collected personal and professional sociodemographic characteristics of family physicians.\u003c/p\u003e\n\u003cp\u003eThe second section consisted of a questionnaire (PA Knowledge Questionnaire) assessing knowledge about anaphylaxis, containing 29 items that were specifically developed for this study and is presented in Table 2. As no validated instrument was available to assess knowledge of PA, the survey was developed based on a comprehensive literature review and the World Allergy Organization (WAO) guidelines.[11] Each correct response was scored as 1 point. The Cronbach\u0026rsquo;s alpha coefficient for internal consistency was calculated as 0.835, indicating high reliability of the \u0026ldquo;PA Knowledge Questionnaire\u0026rdquo;.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe third section focused on physicians\u0026rsquo; experience with PA cases, including whether they had encountered or treated such cases, and whether they had an emergency action plan for anaphylaxis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included family physicians aged 24\u0026ndash;65 years who were actively working in Family Health Centers (FHCs) within the boundaries of Istanbul and voluntarily agreed to participate. Physicians who were not actively employed in an FHC in Istanbul or who declined to participate were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Clinical Research Ethics Committee of Başakşehir \u0026Ccedil;am and Sakura City Hospital (Approval No: 2022.03.88, Protocol Code: KAEK/2022.03.88).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsidering that approximately 5000 family physicians were working in Istanbul at the time, a 95% confidence level and a 5% margin of error were used to determine the required sample size, which was calculated as 321 participants. This sample size was deemed adequate to ensure sufficient statistical power and generalizability of the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using IBM SPSS Statistics version 25.0. Continuous variables were expressed as mean \u0026plusmn; standard deviation (Mean \u0026plusmn; SD) and median (IQR), while categorical variables were presented as number (n) and percentage (%).\u003c/p\u003e\n\u003cp\u003eNormality was tested using Skewness and Kurtosis values.\u003c/p\u003e\n\u003cp\u003eThe Mann\u0026ndash;Whitney U test was used to compare two groups, and the Kruskal\u0026ndash;Wallis H test was applied for comparisons involving three or more groups. When a significant difference was detected, Dunn\u0026rsquo;s post-hoc test was conducted.\u003c/p\u003e\n\u003cp\u003eA \u003cem\u003ep\u003c/em\u003e-value of \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 321 family physicians participated in the study. The mean age of participants was 38.15 \u0026plusmn; 9.36 years, and 65.7% were aged 40 years or younger. Among them, 57.3% were female, and 41.7% had 6\u0026ndash;15 years of professional experience. Approximately 30.8% of participants were specialists in family medicine. Descriptive characteristics of the physicians are presented in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eParticipants demonstrated a\u0026nbsp;\u003cstrong\u003ehigh level of knowledge\u003c/strong\u003e regarding pediatric anaphylaxis.\u003cbr\u003eThe percentage of correct responses for respiratory symptoms such as dyspnea and stridor was \u003cstrong\u003e96.6%\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e and for uvular and periorbital edema\u0026nbsp;\u003cstrong\u003e93.1%\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003cbr\u003eCorrect responses for cutaneous symptoms such as urticaria and pruritus were\u0026nbsp;\u003cstrong\u003e88.2%\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003cbr\u003eAdditionally, \u003cstrong\u003e97.8%\u003c/strong\u003e of participants correctly identified \u003cstrong\u003eadrenaline\u003c/strong\u003e as the most effective treatment, and the correct response rate for the \u003cstrong\u003eadrenaline dosage\u003c/strong\u003e question was \u003cstrong\u003e79.8%\u003c/strong\u003e \u003cstrong\u003e(Table 2).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e presents the participants\u0026rsquo; mean score on the PA Knowledge Questionnaire. The Cronbach\u0026rsquo;s alpha coefficient for internal consistency was calculated as 0.835, indicating high reliability of the PA Knowledge Questionnaire.\u003c/p\u003e\n\u003cp\u003eThe correlation analyses between selected numerical variables and the PA Knowledge Questionnaire scores are presented in \u003cstrong\u003eTable 4.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalysis revealed statistically significant relationships between the knowledge scores and several variables, including age, having encountered a pediatric anaphylaxis case, recognition of signs and symptoms, knowledge of adrenaline auto-injectors, availability of adrenaline in the FHC, and the presence of an emergency action plan. Physicians aged \u0026le; 40 years scored significantly higher than those aged over 40 years (Z = \u0026minus;2.741, p = 0.006). No significant differences were observed in knowledge scores according to gender (p = 0.637) or years of experience (p = 0.108*).Family physicians who had previously received training on pediatric anaphylaxis scored significantly higher than those who had not (Z = \u0026minus;4.193, p \u0026lt; 0.001*). Those who had encountered anaphylaxis cases, knew about AAIs, had adrenaline available, or had an emergency action plan in their FHC also demonstrated significantly higher knowledge levels (p \u0026lt; 0.05*). \u003cstrong\u003e(Table 5)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants who had previously received training on pediatric anaphylaxis scored significantly higher than those without such training (Z = \u0026minus;4.193, p \u0026lt; 0.001). Likewise, physicians who reported being knowledgeable about anaphylaxis, who had encountered pediatric anaphylaxis cases, and those who were familiar with AAI demonstrated significantly higher knowledge scores compared with their counterparts (p \u0026lt; 0.05).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, it was observed that family physicians had a high level of knowledge regarding pediatric anaphylaxis (PA). Nearly half of the participants (47%) reported having previously received training on pediatric anaphylaxis, and the vast majority (98.1%) were aware that allergic reactions could be life-threatening. In addition, 86.9% stated that they were knowledgeable about PA in general.\u003c/p\u003e\n\u003cp\u003eThe rate of encountering pediatric patients with anaphylaxis in Family Health Centers (FHCs) was 13.1%, and 20.9% of the physicians reported having treated a child with anaphylaxis. These findings highlight the importance of knowledge and preparedness in primary care. In a study conducted in Saudi Arabia, more than 60% of physicians had never treated a patient with anaphylaxis (12), while another study found that 53.7% of physicians had encountered such cases.[13]\u003c/p\u003e\n\u003cp\u003eIn the present study, the rate of availability of adrenaline in FHCs was 97.8%, while 60.1% of physicians reported having an anaphylaxis emergency action plan. Although adrenaline is among the essential drugs required to be available in FHCs, an emergency action plan is not mandatory.\u003c/p\u003e\n\u003cp\u003eThe mean score on the Pediatric Anaphylaxis Knowledge Questionnaire was 20.91 \u0026plusmn; 5.13, indicating that family physicians generally possess a high level of knowledge regarding PA. In a 2012 study conducted by Erko\u0026ccedil;oğlu et al., the mean knowledge level of family physicians regarding anaphylaxis was found to be 47.2%.[14] In the present study, the correct response rate for common respiratory symptoms such as dyspnea and stridor was 96.6%, and 93.1% correctly identified uvular and periorbital edema as anaphylactic signs. Similarly, Cambaz Kurt et al. reported a 99% recognition rate among pediatricians for respiratory symptoms of anaphylaxis.[15] Since pediatric vaccinations are routinely administered in FHCs, it is essential for family physicians to have knowledge comparable to that of pediatricians regarding pediatric anaphylaxis.\u003c/p\u003e\n\u003cp\u003eIn our study, the rate of recognizing atypical symptoms such as nausea and vomiting was 63%, which is lower than the 86% reported among pediatric emergency physicians.[16] Another study by Pimentel-Hayashi et al. reported lower recognition rates of atypical signs among pediatricians (56.4%) and internal medicine specialists (58.2%), while surgeons showed higher awareness (75%), possibly due to the risk of intraoperative anaphylaxis in anesthesia-related procedures.[17] To our knowledge, there is no previous study evaluating family physicians\u0026rsquo; knowledge of atypical symptoms of pediatric anaphylaxis.\u003c/p\u003e\n\u003cp\u003eIn the present study, 97.8% of participants correctly identified adrenaline as the most urgent and effective treatment for anaphylaxis. Reported rates in the literature vary across specialties\u0026mdash;from 29% to 40.5% among general physicians (18,19), 99.2% among pediatricians (15), and 88.8\u0026ndash;93.4% among family physicians.[20]\u003c/p\u003e\n\u003cp\u003eThe correct response rate regarding the appropriate dose of adrenaline in pediatric anaphylaxis was 79.8% in our study. Previous studies have reported rates ranging from 16.6% to 59.6%.[11,14,19\u0026ndash;21] The higher rate observed in our study suggests an improvement in clinical awareness among family physicians. The rate of correctly identifying the maximum dose of adrenaline was 61.7%, although no comparable data were found in the literature. This finding is clinically relevant since knowledge of repeat dosing may affect patient outcomes.\u003c/p\u003e\n\u003cp\u003eIn our study, 81% of participants correctly identified the route of adrenaline administration. In contrast, earlier studies reported lower rates: 34% among pediatricians in 2009 (22), 28.7% among family physicians in 2013 (14), and 49.2% among physicians from mixed specialties.[19] These data suggest that knowledge about adrenaline administration has improved over time.\u003c/p\u003e\n\u003cp\u003eWhen asked about the side effects of adrenaline, the most frequently recognized symptom was fear or restlessness (75.7%). Although data on this topic are scarce, awareness of potential side effects is important for clinicians administering life-saving treatments.\u003c/p\u003e\n\u003cp\u003eIn this study, 88.5% of physicians were aware of AAI, yet only 12% had ever prescribed one. In the United Kingdom, the rate of AAI prescription by family physicians increased by 33% over 12 years.[23] In Turkey, the proportion of physicians familiar with AAIs increased from 17.8% in 2009 to 74.4% in 2023 (11), demonstrating a notable improvement in awareness over time.\u003c/p\u003e\n\u003cp\u003eWhen knowledge levels were compared by demographics, younger physicians had significantly higher knowledge scores than older ones. This may reflect increased exposure to updated medical education curricula emphasizing anaphylaxis management. Only 47% of participants stated that they had never received formal training on pediatric anaphylaxis. Alghasham et al. (12) found that physicians aged 40 years or older had higher knowledge levels than younger doctors, likely due to accumulated professional experience.\u003c/p\u003e\n\u003cp\u003eNo significant differences were found between knowledge levels and gender, years of experience, or specialization. However, physicians who had received training on PA, encountered cases, treated affected children, were familiar with AAIs, or had emergency action plans in their FHCs demonstrated significantly higher knowledge scores. These findings indicate that both exposure to real-life cases and ongoing education are critical factors in enhancing clinical competence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main limitation of this study was the absence of a validated and reliable scale to measure physicians\u0026rsquo; knowledge of pediatric anaphylaxis. Therefore, a self-developed questionnaire (Pediatric Anaphylaxis Knowledge Questionnaire) \u0026nbsp;with confirmed internal consistency was used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA key strength of this study is that there are very few studies in the literature evaluating the knowledge and attitudes of family physicians toward pediatric anaphylaxis. Consequently, this research provides valuable baseline data that can guide future studies and educational initiatives.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study, conducted among family physicians in Istanbul, found that participants demonstrated a high level of knowledge regarding pediatric anaphylaxis. Considering that routine pediatric vaccinations are administered in FHCs, along with the increasing prevalence of allergic diseases and the existence of atypical presentations of PA, it is of great importance to enhance awareness and knowledge among family physicians.\u003c/p\u003e\n\u003cp\u003eFurther field-based training programs and research are recommended to strengthen clinical preparedness and improve patient outcomes in pediatric anaphylaxis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAAI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdrenaline Auto-İnjector\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFHC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFamily Health Center\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePediatric Anaphylaxis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods were conducted in accordance with the relevant guidelines and regulations. Informed consent was obtained from all the participants. The study was approved by the Clinical Research Ethics Committee of Başakşehir \u0026Ccedil;am and Sakura City Hospital (Approval No: 2022.03.88, Protocol Code: KAEK/2022.03.88). The study was conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH\u0026Ouml;, NK and SBA, conceptualised and designed the study, analysed and interpreted the interview data, and were responsible for drafting and writing the original manuscript. NK and EE conducted the literature review. SBA was involved in the interpretation of the data. H\u0026Ouml;, SBA and NK critically reviewed and edited the manuscript. All the authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the family physicians for their participation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbrams EM, Alqurashi W, Fischer DA, Vander Leek TK, Ellis AK. Anaphylaxis AACI. 2024;20(3):62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYu JE, Lin RY. The epidemiology of anaphylaxis. Clin Rev Allergy Immunol. 2018;54(3):366\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: a systematic review. Allergy. 2019;74(6):1063\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCambaz Kurt N. An overview of anaphylaxis in children. Zeynep Kamil Med J. 2021;52(3):116\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartelli A, Ippolito R, Votto M, De Filippo M, Brambilla I, Calvani M, et al. What is new in anaphylaxis? Acta Biomed. 2020;91(11\u0026ndash;S):e202000.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuraro A, Roberts G, Worm M, Bil\u0026ograve; MB, Brockow K, Fern\u0026aacute;ndez Rivas M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlvarez-Perea A, Ameiro B, Morales C, Zambrano G, Rodr\u0026iacute;guez A, Guzm\u0026aacute;n M, et al. Anaphylaxis in the pediatric emergency department: analysis of 133 cases after an allergy workup. J Allergy Clin Immunol Pract. 2017;5(5):1256\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePoowuttikul P, Seth D. Anaphylaxis in children and adolescents. Pediatr Clin North Am. 2019;66(5):995\u0026ndash;1005.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRibeiro M, Chong Neto HJ, Rosario Filho NA. Diagnosis and treatment of anaphylaxis: there is an urgent needs to implement the use of guidelines. Einstein (Sao Paulo). 2017;15(4):500\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMostmans Y, Grosber M, Blykers M, Mols P, Naeije N, Gutermuth J. Adrenaline in anaphylaxis treatment and self-administration: experience from an inner city emergency department. Allergy. 2017;72(3):492\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTurner PJ, Worm M, Ansotegui IJ, El-Gamal Y, Rivas MF, Fineman S, et al. Time to revisit the definition and clinical criteria for anaphylaxis? World Allergy Organ J. 2019;12(10):100066.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlghasham YA, Alhumaidi KA, Alharbi AM, Alkhalifah YS. Healthcare providers' perception and practice toward anaphylaxis in children in the Qassim Region of Saudi Arabia. Cureus. 2023;15(7):e41366.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlsaleem HN, Almuzaini AS, Aldakheel FN, Almuhaisni R, Alsharekh NA, Alharkan MK, et al. Knowledge and preparedness of physicians in relation to anaphylaxis at primary healthcare centers in Al-Qassim, Saudi Arabia. Cureus. 2024;16(3):e57153.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eErko\u0026ccedil;oğlu M, Civelek E, Azkur D, \u0026Ouml;zcan C, \u0026Ouml;zt\u0026uuml;rk K, Kaya A, et al. Knowledge and attitudes of primary care physicians regarding food allergy and anaphylaxis in Turkey. Allergol Immunopathol (Madr). 2013;41(5):292\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKurt NC, Kutlu NO. Evaluation of pediatricians' awareness about anaphylaxis. Eur Rev Med Pharmacol Sci. 2023;27(5Suppl):53\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlabarri M, Gonzalez-Peris S, V\u0026aacute;zquez P, Gonz\u0026aacute;lez-Posada A, Sanz N, Vinuesa A, et al. Management of anaphylaxis in Spain: pediatric emergency care providers' knowledge. Eur J Emerg Med. 2019;26(3):163\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePimentel-Hayashi JA, Navarrete-Rodriguez EM, Moreno-Laflor OI, Del Rio-Navarro BE. Physicians' knowledge regarding epinephrine underuse in anaphylaxis. Asia Pac Allergy. 2020;10(4):e40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMunblit D, Treneva M, Korsunskiy I, Asmanov A, Pampura A, Warner JO. A national survey of Russian physicians' knowledge of diagnosis and management of food-induced anaphylaxis. BMJ Open. 2017;7(7):e015901.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl-Sayed ZA, El-Owaidy R, Hussein SM, Hossam D, El-Sawi IH, Adel A, et al. Physicians' knowledge and practice concerning diagnosis and management of anaphylaxis: the situation in Egypt. AfJEM. 2021;11(4):464\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Ouml;zkars MY. Anaphylaxis from the eyes of family physicians. J Curr Pediatr. 2019;17(1):34\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArga M, Topal E, Yılmaz S, Erdemli PC, Bı\u0026ccedil;akcı K, Bakırtaş A. Healthcare workers` knowledge level regarding anaphylaxis and usage of epinephrine auto-injectors. Turk J Pediatr. 2021;63(3):372\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCetinkaya F, Z\u0026uuml;barioğlu AU, G\u0026ouml;ktaş S. Pediatricians' knowledge about recent advances in anaphylaxis treatment in Istanbul, Turkey. Turk J Pediatr. 2009;51(1):19\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiwakar L, Cummins C, Ryan R, Marshall T, Roberts T. Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study. Br J Gen Pract. 2017;67(657):e300\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anaphylaxis, family practice, primary healthcare, vaccination","lastPublishedDoi":"10.21203/rs.3.rs-8080439/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8080439/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAnaphylaxis is an acute-onset, life-threatening systemic hypersensitivity reaction. Pediatric anaphylaxis (PA) is important in family health centers (FHC) due to pediatric vaccination and some treatment practices. The aim of this study was to analyze the knowledge and attitudes of family physicians regardingPA.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study is a cross-sectional, survey study. The study included 321 family physicians between the ages of 24 and 65 who were actively working in FHC within the borders of Istanbul and agreed to participate in the study. The survey consisted of three sections: the first section included the family physicians\u0026rsquo; personal and professional characteristics; the second section comprised a knowledge questionnaire designed to measure the physicians\u0026rsquo; level of knowledge about PA; and the third section assessed the situation regarding PA in FHC.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn this study, the mean age of the 321 participating family physicians was 38.15\u0026thinsp;\u0026plusmn;\u0026thinsp;9.36 years; 57.3% were female, and 41.7% had between 6\u0026ndash;15 years of professional experience. Among the participants, 47% had received training on PA, 13.1% had encountered a PA case at FHC, adrenaline was available in 97.8% of the centers, and 60.1% reported having an anaphylaxis emergency action plan in their facility. The mean score of the participants on the anaphylaxis knowledge questionnaire was 20.91\u0026thinsp;\u0026plusmn;\u0026thinsp;5.13 (min:8, max:29) point. Participants aged 40 years or younger scored significantly higher on the anaphylaxis knowledge questionnaire compared to those over 40 years of age (p\u0026thinsp;=\u0026thinsp;0.006). Similarly, those who had received training on PA (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), those who had encountered a PA case (p\u0026thinsp;=\u0026thinsp;0.021), those whose FHC had adrenaline available (p\u0026thinsp;=\u0026thinsp;0.018), and those with an anaphylaxis emergency action plan in FHC (p\u0026thinsp;=\u0026thinsp;0.032) also demonstrated significantly higher knowledge scores.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eIn this study conducted with family physicians in Istanbul, it was found that their level of knowledge regarding pediatric anaphylaxis was high. Due to the vaccination practices in pediatric age groups, physicians\u0026rsquo; awareness and knowledge in this area are of critical importance. Therefore, it is essential to increase field-based training and scientific research on this topic.\u003c/p\u003e","manuscriptTitle":"Knowledge and Attitudes of Family Physicians Regarding Pediatric Anaphylaxis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 13:42:55","doi":"10.21203/rs.3.rs-8080439/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-05T14:41:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-14T06:00:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-07T03:13:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-03T18:11:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212923590277199309468340034278387190608","date":"2026-03-03T15:47:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32384018874187141776355402225277432309","date":"2026-03-03T11:48:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151951931116207359597872653263230275985","date":"2026-03-02T06:58:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-19T11:29:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62580187990239493160825517544448325843","date":"2025-12-12T11:30:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-04T18:14:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-03T12:41:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-14T06:13:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-13T21:07:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-11-13T21:04:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e6f7b122-ef89-4e06-8e06-cbdfe8542c81","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-18T18:23:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 13:42:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8080439","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8080439","identity":"rs-8080439","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}