To cite this article: Song TT, Worm M, Lieberman P. Anaphylaxis treatment: current barriers to adrenaline auto-injector use.
AbstractAnaphylaxis is a life-threatening condition that is increasing in prevalence in the developed world. There is universal expert agreement that rapid intramuscular injection of adrenaline is life-saving and constitutes the first-line treatment of anaphylaxis. The unpredictable nature of anaphylaxis and its rapid progression makes necessary the availability of a portable emergency treatment suitable for self-administration. Thus, anaphylaxis treatment guidelines recommend that at-risk patients are provided with adrenaline auto-injectors (AAIs). Despite these clear recommendations, current emergency treatment of anaphylaxis continues to be inadequate in many cases. The aim of this review is to highlight the barriers that exist to the use and availability of AAIs and that prevent proper management of anaphylaxis. In addition, we review the characteristics of all AAIs that are presently available in Europe and the USA and discuss the need for regulatory requirements to establish the performance characteristics of these devices.
Failure to administer epinephrine promptly has resulted in fatalities. Education about anaphylaxis and prompt treatment are critical for patients and their caregivers.
A naphylaxis is potentially fatal but can be prevented if the trigger is identifi ed and avoided, and death can be avoided if episodes are treated promptly. A consensus defi nition of anaphylaxis has been diffi cult to achieve, with slight variations among international guidelines. The World Allergy Organization classifi es anaphylaxis as immunologic, nonimmunologic, or idiopathic. 1 The National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network highlight clinical symptoms and criteria. 2 The International Consensus on Food Allergy describes reactions as being immunoglobulin E (IgE)-mediated, cell-mediated, or a combination of the 2 mechanisms. 3 Despite the subtle differences in these definitions, all 3 international organizations have a common recommendation for anaphylaxis: once it is diagnosed, epinephrine is the treatment of choice. ■ EPINEPHRINE IS THE TREATMENT OF CHOICE FOR ANAPHYLAXIS Anaphylaxis commonly results from exposure to foods, medications, and Hymenoptera venom. 4 Avoiding triggers is key in preventing anaphylaxis but is not always possible. Although epinephrine is the cornerstone of the emergency treatment of anaphylaxis, many patients instead receive antihistamines and corticosteroids as initial therapy. Some take these medications on their own, and some receive them in emergency departments and outpatient clinics. 5 Diphenhydramine, a histamine 1 receptor antagonist, is often used as a fi rst-line medication. But diphenhydramine has a slow onset of action, taking 80 minutes after an oral dose REVIEW Dr. Song has disclosed membership on advisory committees or review panels for Allergopharma, and teaching and speaking for Novartis and Teva. Dr. Lieberman has disclosed consulting for Kaléo.
Epinephrine auto-injectors have different needle lengths. Using the right device with appropriate needle length based on BMI, obesity, and employing the proper technique can improve the outcome in an anaphylactic event.
Our study suggests poor adherence in patients and caregivers to anaphylaxis guidelines recommending more than 1 EAI available at all times and implies that this can result in adverse outcomes.
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