Hazards of unintentional injection of epinephrine from autoinjectors: a systematic review

Simons, F. Estelle R.; Lieberman, Phillip; Read, Edward; Edwards, Eric S.

doi:10.1016/s1081-1206(10)60332-8

Cited by 101 publications

(77 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…45 Devices and procedures change over time, and there is a constant need to improve pharmacists' skills in this area, so they can better train those at risk of anaphylaxis. 13,35,43,44,46 Approximately two-thirds of e-learners in our study were able to correctly order all of the steps required for both EpiPen and Anapen administration 7 months after training. Lecture participants achieved results similar to those for elearners, even though they had hands-on practice with devices during training.…”

Section: Discussionmentioning

confidence: 71%

Long-term Effectiveness of Online Anaphylaxis Education for Pharmacists

Salter

Vale

Sanfilippo

et al. 2014

American Journal of Pharmaceutical Education

View full text Add to dashboard Cite

Objective. To evaluate the long-term effectiveness of an Australasian Society of Clinical Immunology and Allergy (ASCIA) anaphylaxis e-learning program compared to lectures or no training. Design. A controlled interrupted-time-series study of Australian pharmacists and pharmacy students who completed ASCIA anaphylaxis e-learning or lecture programs was conducted during 2011-2013. Effectiveness was measured using a validated test administered pretraining, posttraining, and 3 and 7 months after training. Assessment. All learning groups performed significantly better on all posttests compared to the pretest, and compared to a control group (p,0.001). The proportion of e-learners achieving the minimum standard for anaphylaxis knowledge improved from 45% at pretest to 87% at 7 months. Conclusion. The ASCIA e-learning program significantly increased anaphylaxis knowledge. The high proportion of participants achieving the minimum standard at 7 months indicates long-term knowledge change.

show abstract

Section: Discussionmentioning

confidence: 71%

Long-term Effectiveness of Online Anaphylaxis Education for Pharmacists

Salter

Vale

Sanfilippo

et al. 2014

American Journal of Pharmaceutical Education

View full text Add to dashboard Cite

show abstract

“…These unintentional injections might not only result in injury but also in partial or complete loss of the epinephrine dose for the person having an anaphylactic episode, the so-called ''lost dose hazard.'' 174,175 Epinephrine autoinjectors with improved design, including needle protection features, are being introduced.…”

Section: Long-term Risk Reduction: Prevention Of Anaphylaxismentioning

confidence: 99%

Anaphylaxis

Simons

2010

Journal of Allergy and Clinical Immunology

378

368

View full text Add to dashboard Cite

Anaphylaxis occurs commonly in community settings. The rate of occurrence is increasing, especially in young people. Understanding potential triggers, mechanisms, and patient-specific risk factors for severity and fatality is the key to performing appropriate risk assessment in those who have previously experienced an acute anaphylactic episode. The diagnosis of anaphylaxis is based primarily on clinical criteria and is valid even if the results of laboratory tests, such as serum total tryptase levels, are within normal limits. Positive skin test results or increased serum specific IgE levels to potential triggering allergens confirm sensitization but do not confirm the diagnosis of anaphylaxis because asymptomatic sensitization is common in the general population. Important patient-related risk factors for severity and fatality include age, concomitant diseases, and concurrent medications, as well as other less well-defined factors, such as defects in mediator degradation pathways, fever, acute infection, menses, emotional stress, and disruption of routine. Prevention of anaphylaxis depends primarily on optimal management of patient-related risk factors, strict avoidance of confirmed relevant allergen or other triggers, and, where indicated, immunomodulation (eg, subcutaneous venom immunotherapy to prevent Hymenoptera sting-triggered anaphylaxis, an underused, potentially curative treatment). The benefits and risks of immunomodulation to prevent food-triggered anaphylaxis are still being defined. Epinephrine (adrenaline) is the medication of first choice in the treatment of anaphylaxis. All patients at risk for recurrence in the community should be equipped with 1 or more epinephrine autoinjectors; a written, personalized anaphylaxis emergency action plan; and up-to-date medical identification. Improvements in the design of epinephrine autoinjectors will help to optimize ease of use and safety. Randomized controlled trials of pharmacologic agents, such as antihistamines and glucocorticoids, are needed to strengthen the evidence base for treatment of acute anaphylactic episodes.

show abstract

“…89 The ability to use autoinjectors is not intuitive, and even health care professionals need to be trained to use them correctly and safely. 90,91 Failure to inject epinephrine promptly in patients with anaphylaxis occurs because of a lack of recognition of signs and symptoms, delayed diagnosis, perception that the episode is mild, preference for using an oral H 1 -antihistamine, and lack of availability or affordability of an epinephrine autoinjector. 92,93 Concerns about adverse effects, especially potential myocardial infarction and cardiac arrhythmias, need to be weighed against the cardiac risks of untreated anaphylaxis, including the unmasking of subclinical coronary artery disease (see the ''Clinical diagnosis'' section).…”

Section: Self-injectable Epinephrinementioning

confidence: 99%