To the Editor, Intramuscular adrenaline injection is the first-line treatment of anaphylaxis. 1 More serious and even fatal or biphasic reactions may occur if there is a delay in administering it. 1 Adrenaline injection for anaphylaxis that occurs outside of a healthcare setting should be immediately followed by a call to emergency medical services (EMSs) ('911' in North America, '112' in Europe). 1 Before discharge from the emergency care unit (ECU), an adrenaline autoinjector (AAI) should be prescribed with clearly written instructions for its use and safety recommendations. 1 Despite international guidelines and education about the treatment of anaphylaxis, adrenaline is underused by caregivers and healthcare professionals. This study aimed to understand the factors associated with the underuse of adrenaline in children experiencing anaphylaxis. Preliminary results of this study focusing on the clinical outcome of the anaphylaxis manifestations have been previously reported. 2 All children (≤15 years) admitted for anaphylaxis (2015-2017) to one of 18 paediatric ECUs in the Nord-Pas-de-Calais region of France were prospectively included. Diagnosis of anaphylaxis was based on the criteria proposed by the National Institute of Allergy and Infectious Disease (NIAID)/Food Allergy and Anaphylaxis Network symposium. 3 All medical records were reviewed by an
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