Physicians prescribe adrenaline autoinjectors, do parents use them when needed?

Main Article Content

S. Esenboga
M. Ocak
P.G. Cetinkaya
U.M. Sahiner
O. Soyer
B. Buyuktiryaki
B.E. Sekerel

Keywords

Anaphylaxis, Adrenaline autoinjectors, Food allergy, Training

Abstract

Background: Anaphylaxis is a sudden, severe, and potentially life-threatening allergic reaction, affecting a portion of allergic patients. Adrenaline is the first-line medication for anaphylaxis and available in many parts of the world as adrenaline autoinjectors (AAIs).


Objective: Aim of this study was to determine attitudes and knowledge levels of patients/parents regarding the use of AAIs, frequency, and rate of appropriate AAI use and to give a standardized and better education by improving on mistakes during administration.


Method: 190 patients aged 1-18 years who were prescribed AAIs for any reason between 2012 and 2017 in Hacettepe University Pediatric Allergy Unit. Demographic data were collected during face-to-face interview or by telephone. Parents completed a mini-survey regarding use, carriage, and storage of AAI.


Results: Some 190 patients (64.7% male) aged 7.83 (4.99-12.08) years, median (inter-quartile), were included in the study. The indications for AAI prescription were food allergy (78.9%); venom allergy (14.2%); idiopathic anaphylaxis (3.7%); mastocytosis (2.1%); and drug allergy (1.0%). One-fourth of AAI-prescribed patients experienced anaphylaxis requiring the use of AAI within the past five years. However, only 30% of the patients dared to use AAI; only three-quarters of whom had managed to use it correctly.


Conclusion: After prescription of AAI and initial training, patients and parents’ concerns and fears should be taken into consideration and necessary support should be provided. At every opportunity and each clinical visit, not only should training sessions be repeated but also the patients and parents should be psychologically supported.

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References

1. Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report-second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med. 2006;47(4):373-80.

2. Lieberman P, Camargo CA Jr, Bohlke K, Jick H, Miller RL, Sheikh A, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol. 2006;97(5):596-602.

3. Tejedor-Alonso MA, Moro-Moro M, Mugica-Garcia MV. Epidemiology of anaphylaxis: contributions from the last 10 years. J Invest
Allergol Clin Immunol. 2015;25(3):163-75, quiz follow 74-5.

4. Lee S, Hess EP, Lohse C, Gilani W, Chamberlain AM, Campbell RL. Trends, characteristics, and incidence of anaphylaxis in 2001-2010: a population-based study. J Allergy Clin Immunol. 2017;139(1), 182-8 e2.

5. Cetinkaya F, Incioglu A, Birinci S, Karaman BE, Dokucu AI, Sheikh A. Hospital admissions for anaphylaxis in Istanbul, Turkey. Allergy. 2013;68(1):128-30.

6. Orhan F, Canitez Y, Bakirtas A, Yilmaz O, Boz AB, Can D, et al. Anaphylaxis in Turkish children: a multi-centre, retrospective, case study. Clin Exp Allergy. 2011;41(12):1767-76.

7. Kastner M, Harada L, Waserman S. Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature. Allergy. 2010;65(4):435-44.

8. Gold MS, Sainsbury R. First aid anaphylaxis management in children who were prescribed an epinephrine autoinjector device (EpiPen). J Allergy Clin Immunol. 2000;106 1 Pt 1:171-6.

9. Huang SW. A survey of Epi-PEN use in patients with a history of anaphylaxis. J Allergy Clin Immunol. 1998;102(3):525-6.

10. Sicherer SH, Forman JA, Noone SA. Use assessment of self-administered epinephrine among food-allergic children and pediatricians. Pediatrics. 2000;105(2):359-62.

11. Grabenhenrich LB, Dolle S, Moneret-Vautrin A, Kohli A, Lange L, Spindler T, et al. Anaphylaxis in children and adolescents: the European anaphylaxis registry. J Allergy Clin Immunol. 2016;137(4), 1128-37 e1.

12. Ito K, Ono M, Kando N, Matsui T, Nakagawa T, Sugiura S, et al. Surveillance of the use of adrenaline auto-injectors in Japanese children. Allergol Int. 2018;67(2):195-200.

13. Feuille E, Lawrence C, Volel C, Sicherer SH, Wang J. Time trends in food allergy diagnoses, epinephrine orders, and epinephrine administrations in New York City schools. J Pediatr. 2017;190:93-9.

14. Korematsu S, Fujitaka M, Ogata M, Zaitsu M, Motomura C, Kuzume K, et al. Administration of the adrenaline auto-injector at the nursery/kindergarten/school in Western Japan. Asia Pac Allergy. 2017;7(1):37-41.

15. Ninchoji T, Iwatani S, Nishiyama M, Kamiyoshi N, TaniguchiIkeda M, Morisada N, et al. Current situation of treatment for anaphylaxis in a Japanese pediatric emergency center. Pediatr Emerg Care. 2018;34(4), e64-e7.

16. Fleischer DM, Perry TT, Atkins D, Wood RA, Burks AW, Jones SM, et al. Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study. Pediatrics. 2012;130(1):e25-32.

17. Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. 2007;119(4):1016-8.

18. Simons FE, Lieberman PL, Read EJ Jr, Edwards ES. Hazards of unintentional injection of epinephrine from autoinjectors: a systematic review. Ann Allergy Asthma Immunol. 2009;102(4):282-7.

19. Simons FE, Edwards ES, Read EJ Jr, Clark S, Liebelt EL. Voluntarily reported unintentional injections from epinephrine auto-injectors. J Allergy Clin Immunol. 2010;125(2), 419-23 e4.

20. Sicherer SH, Noone SA, Munoz-Furlong A. The impact of childhood food allergy on quality of life. Ann Allergy Asthma Immunol. 2001;87(6):461-4.

21. Primeau MN, Kagan R, Joseph L, Lim H, Dufresne C, Duffy C, et al. The psychological burden of peanut allergy as perceived by adults with peanut allergy and the parents of peanut-allergic children. Clin Exp Allergy. 2000;30(8):1135-43.

22. Kim JS, Sinacore JM, Pongracic JA. Parental use of EpiPen for children with food allergies. J Allergy Clin Immunol. 2005;116(1):164-8.

23. Song TT, Brown D, Karjalainen M, Lehnigk U, Lieberman P. Value of a second dose of epinephrine during anaphylaxis: a patient/caregiver survey. J Allergy Clin Immunol Pract. 2018;6(5):1559-67.