Anaphylaxis and epinephrine auto-injector training: Who will teach the teachers?☆☆☆

Grouhi, Masoud; Alshehri, Mohammed; Hummel, David; Roifman, Chaim M.

doi:10.1016/s0091-6749(99)70134-x

Cited by 98 publications

(67 citation statements)

References 8 publications

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“…Gaps in epinephrine auto-injector use revealed that physicians not only lacked the knowledge on how to use autoinjectors (11,41,59,68,72), but they also did not provide adequate instructional training to patients (1, 11, 22, 25, 32, 43, 49, 50, 59, 63). One study found that patients who were prescribed auto-injectors by their primary care physicians either never carried the device or were less aware of how to activate it compared to those who received their prescription from allergists (22).…”

Section: Auto-injectorsmentioning

confidence: 99%

“…Other gaps were related to physicians' lack of knowledge of the correct dose of auto-injector administration. Few physicians knew the two available doses of epinephrine autoinjectors (40,41,47). Furthermore, one study indicated that some children were incorrectly prescribed a low-dose autoinjector even though they reached a weight of 30 kg, which would require a full dose (28).…”

Section: Auto-injectorsmentioning

confidence: 99%

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Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature

Kastner

Harada

Waserman

2010

Allergy

116

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To cite this article: 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: 435–444.AbstractDiagnosis and management of anaphylaxis can be a challenge because reactions are often unexpected and progress quickly. The focus of anaphylaxis management has mostly been on the acute episode, with little attention given to the long‐term management of patients at risk. This is compounded by conflicting information in current guidelines and a general lack of agreement among clinicians about which management strategies are the most appropriate. We systematically reviewed the literature to identify and summarize studies that investigated gaps in anaphylaxis management. Our search included MEDLINE, EMBASE, CINAHL, and Evidence‐Based Medicine Reviews. Studies were included if they addressed an outcome describing gaps in anaphylaxis knowledge, education, anaphylaxis management, and quality of life (QOL). Populations of interest were health care professionals involved in the care of patients at risk for anaphylaxis, and patients of any age, their parents, caregivers, and teachers in primary care, hospital or community settings. Of 5014 citations that were identified, the final 59 studies (selected from 75 full‐text articles) met the inclusion criteria. Two hundred and two gaps were identified and classified according to major themes: gaps in knowledge and anaphylaxis management (physicians and patients); gaps in follow‐up care (physicians); and QOL of patients and caregivers. Findings from this systematic review revealed gaps in anaphylaxis management at the level of physicians, patients, and the community. Findings will be used to provide a basis for developing interventional strategies to help address these deficiencies.

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Section: Auto-injectorsmentioning

confidence: 99%

Section: Auto-injectorsmentioning

confidence: 99%

Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature

Kastner

Harada

Waserman

2010

Allergy

116

View full text Add to dashboard Cite

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“…Studies have also demonstrated that many health care professionals are uncertain about how to use an epinephrine autoinjector and thus cannot properly instruct their patients. 76,77 Available resources may help physicians develop treatment plans and resolve any therapeutic quandaries. 17,18,65 Examples of written action plans can be downloaded over the Internet (see Additional Educational Resources).…”

Section: Use Of Epinephrine By Health Care Professionalsmentioning

confidence: 99%

Epinephrine: The Drug of Choice for Anaphylaxis--A Statement of the World Allergy Organization

Kemp¹,

Lockey²,

Simons³

2008

World Allergy Organization Journal

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Anaphylaxis is an acute and potentially lethal multisystem allergic reaction. Most consensus guidelines for the past 30 years have held that epinephrine is the drug of choice and the first drug that should be administered in acute anaphylaxis. Some state that properly administered epinephrine has no absolute contraindication in this clinical setting. A committee of anaphylaxis experts assembled by the World Allergy Organization has examined the evidence from the medical literature concerning the appropriate use of epinephrine for anaphylaxis. The committee strongly believes that epinephrine is currently underused and often dosed suboptimally to treat anaphylaxis, is underprescribed for potential future self-administration, that most of the reasons proposed to withhold its clinical use are flawed, and that the therapeutic benefits of epinephrine exceed the risk when given in appropriate intramuscular doses.Key Words: anaphylaxis, epinephrine, management, prevention (WAO Journal 2008;S18YS26) E pinephrine is the treatment of choice and the first drug administered for acute anaphylaxis, as confirmed internationally by most consensus anaphylaxis guidelines published in the English language over the past 30 years. 1Y17Therapeutic recommendations for epinephrine use in anaphylaxis are largely based on clinical pharmacology studies, clinical observation, and animal models.Anaphylaxis often occurs outside of a medical setting, for example, after food ingestion or an insect sting, and the onset may be sudden and without warning. Severity varies from episode to episode even with an identical stimulus in the same patient. Recognition and diagnosis of anaphylaxis is sometimes difficult for health care professionals and for individuals without medical training. 18Few controlled clinical trials, and no placebo-controlled trials, have been performed in anaphylaxis because of the nature of the disease. 19 Randomization to a nonepinephrine treatment would be unethical because of the preponderance of data showing that expeditious treatment with epinephrine is optimal, if not critical, for survival in many instances. 20Y25 The following discussion reviews current evidence for the use of epinephrine in anaphylaxis. DEFINITIONThe traditional nomenclature for anaphylaxis reserves the term anaphylactic for immunoglobulin E (IgE)Ydependent reactions and the term anaphylactoid for IgE-independent events, which are clinically indistinguishable. The World Allergy Organization, a worldwide federation of national and regional allergy and clinical immunology societies and organizations dedicated to raising awareness and advancing excellence in clinical care, education, research, and training in allergy and clinical immunology, recommends that this terminology be replaced with immunologic (IgE-mediated and non-IgEYmediated [eg, IgG and immune complex complementYmediated]) and nonimmunologic anaphylaxis. 26 Therefore, in this article, the term anaphylaxis refers to both immunologic and nonimmunologic anaphylaxis. METHODSA literature...

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“…Of particular concern, however, is that although awareness of the need for patient education is increasing, a recent study reported that of physicians who commonly prescribe auto-injectors (emergency room physicians, pediatricians, and family practitioners), only 25% could correctly demonstrate the proper technique for use [43]. In addition, 76% did not know the two available dose strengths for EpiPens, and 86% did not have a placebo trainer with which to educate their patients.…”

Section: Epinephrine Auto-injectorsmentioning

confidence: 99%

The role of epinephrine in the treatment of anaphylaxis

Ellis

Day

2003

Curr Allergy Asthma Rep

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Epinephrine is the cornerstone of anaphylaxis management. Its administration should be immediate upon evidence of the occurrence of anaphylaxis. Delays in administration may be fatal. The most appropriate administration is 0.3 to 0.5 mL of 1:1000 dilution intramuscularly for adults and 0.01 mg/kg for children, given in the lateral thigh. Patients with known anaphylactic reactivity should be prescribed an epinephrine auto-injector to be carried at all times for treatment of potential recurrences. Education of the patient or parent regarding the proper use of this tool is paramount.

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Anaphylaxis and epinephrine auto-injector training: Who will teach the teachers?☆☆☆

Cited by 98 publications

References 8 publications

Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature

Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature

Epinephrine: The Drug of Choice for Anaphylaxis--A Statement of the World Allergy Organization

The role of epinephrine in the treatment of anaphylaxis

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