Anaphylaxis treatment: current barriers to adrenaline auto-injector use

Abstract

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.

Anaphylaxis: Are doctors adequately aware? A study on perceptions and practices among first contact-level doctors in state healthcare institutions in Gampaha district

“…However, even in developed countries, unsatisfactory prescribing practices due to limited awareness by the health professionals is shown to be a barrier to optimal AAI use. 20 Only 2% (n=2) of our participants had a perfect score in the assessment of diagnostic accuracy. Most participants were unable to spot the single case in the questionnaire that described an allergic reaction, hence over-diagnosed anaphylaxis.…”

“…Hence, our findings raise similar concerns as those stemming from multiple studies all over the world on suboptimal use of adrenaline and inappropriate use of second-line drugs such as steroids and antihistamines in place of the first line drug. 13,19,20,23 Limitations of this study include, not including all the first contact level physicians including those who work solely in the private sector and not having a higher response rate. As the questionnaires were not administered then and there, the possibility of the participants obtaining assistance of various sources of knowledge prior to completing the questionnaire, and hence, having a lower actual knowledge than reported in this study cannot be ruled out.…”

Awareness of Physicians and Healthcare Providers Concerning Anaphylaxis and Epinephrine Auto-Injector Usage at a Tertiary Care Hospital

“…Anafilaksi nedeniyle gerçekleşen ölümlerin en sık nedeninin adrenalin uygulamasındaki gecikmeden olması önemli bir sorundur (4). Bu eksikliklerin nedenlerine yönelik olarak yapılmakta olan çalışmaların sayısı her geçen gün artmaktadır (5)(6)(7)(8). Uluslararası literatürde anafilaksi tedavisi ve bu tedaviyi uygulayan sağlık çalışanlarının bilgi düzeyi ve uygulama pratiklerine yönelik olarak çok sayıda araştırma olmasına rağmen, ülkemizde bu konuda yapılmış çalışmalar kısıtlıdır (9)(10)(11)(12)(13)(14)(15).…”

Exploring mHealth Participation for Emergency Response Communities

“…It may trigger life-threatening cardiopulmonary compromise, often with skin and mucosal changes such as urticaria and angioedema. With the onset of anaphylaxis an immediate intramuscular (im) adrenaline injection is the first-line of treatment and can be lifesaving and it has been noted that there are no absolute contraindications to the prescription and utilization of self-injectable adrenaline (Song, Worm, & Lieberman, 2014 Adherence by chronic patients to medical regimens is recognized to be dismally low (Sabaté, 2003). With anaphylaxis in particular, it has been noted that many patients who have been prescribed epinephrine auto-injectors, because of a previous anaphylactic attack, do not carry them with studies showing that <30% of these patients carried it at all times (Johnson & Parker, 2006;Kastner, Harada, & Waserman, 2010;Song et al, 2014).…”

“…Despite this, significant delay in epinephrine administration (i.e.,≥ 5 min) was also found to be an important gap in anaphylaxis management (Bilò et al, 2016;Kastner et al, 2010). The onset of anaphylaxis can be sudden however it is generally recognized (Song et al, 2014) that there is sufficient time and awareness on the part of the patient to initiate use of an epinephrine auto-injector should one be available. During this same time period a patient would be capable of initiating emergency use of an ERC app to summon help.…”