Patient Carrying Time, Confidence, and Training with Epinephrine Autoinjectors: The RACE Survey

Portnoy, Jay M.; Wade, Rolin L.; Kessler, Catherine

doi:10.1016/j.jaip.2019.03.021

Cited by 18 publications

(7 citation statements)

References 35 publications

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“…65 Providing adrenaline auto-injectors (AAI) to patients at risk of anaphylaxis encounters challenges related to their availability, which is mostly limited to high-income countries, varied national regulations in prescribing and high cost. 70 When prescribed, AAI are only carried at all times by half of the patients 71 and mistakes in use are frequent among both patients 72 and medical staff. 73 Meeting the needs of both food-allergic children undergoing immunotherapy and those continuing strict avoidance in the same environment, for example school or household with two allergic siblings managed differently, is an arising challenge.…”

Section: Allergen Avoidancementioning

confidence: 99%

Update on food allergy

Peters

Krawiec

Santos

2021

Pediatric Allergy Immunology

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Food allergy (FA) can be classified into IgE-and non-IgE-mediated depending on the involvement of IgE in its pathogenesis. In this review, we are focusing on IgE-mediated food allergy. FA affects about 8% of children in the Western countries and seems to be rising in other parts of the world such as in Vietnam and South Africa, and other parts of Asia and Africa, particularly in urban rather than rural areas. [1][2][3][4] The prevalence of FA has increased over the recent decades, as has the number of hospitalizations for food-induced anaphylaxis, following what seems to be the 'second wave of the allergy epidemic' after the rise in the prevalence of asthma and respiratory allergy in previous decades. [5][6][7] Pouessel et al 8 have shown that foods caused 37% of cases of ICU admissions for anaphylaxis and 79% of recurrent anaphylaxis. Self-reported FA is even more common with an often underappreciated impact. 1 Gupta et al 1 report that about 40% of food allergic children report multiple food allergies, often severe food allergies, and carry an adrenaline auto-injector. In Western countries, such as the USA and the UK, FA affects disproportionally children from ethnic minorities, such as children of Afro-Caribbean descent. 1,9,10 Whether this has to do with genetic predisposition in face of environmental factors related to the modern lifestyle

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Section: Allergen Avoidancementioning

confidence: 99%

Update on food allergy

Peters

Krawiec

Santos

2021

Pediatric Allergy Immunology

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“…Other advantages of IN epinephrine include its portability and convenient administration method, which may increase the potential for carrying the device more regularly and decrease user anxiety, thereby decreasing the risk of delayed treatment 10,43 . IN administration avoids accidental finger sticks or skin lacerations that may be experienced during IM administration 7,9 .…”

Section: Discussionmentioning

confidence: 99%

Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects

Dretchen

Mesa

Robben³

et al. 2020

Pharmacology Res & Perspec

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Epinephrine is the standard of care for the treatment of severe allergy and anaphylaxis. Epinephrine is most often administered through the intramuscular (IM) route via autoinjector. The current study aimed to evaluate an alternative method of epinephrine treatment through intranasal (IN) delivery in dogs. The pharmacokinetic (PK) parameters of maximum plasma concentration (Cmax), time to reach maximum plasma concentration (Tmax), and area under the plasma concentration‐time curve from 0 to 90 minutes (AUC0–90) were observed after IN epinephrine (2, 3, 4, 5, 10, and 20 mg) and IM epinephrine via autoinjector (0.15 and 0.3 mg) for 90 minutes. Heart rate effects were measured after IN (2 and 5 mg) and IM (0.15 and 0.3 mg) epinephrine administration. IN epinephrine (5 mg) demonstrated significantly greater plasma epinephrine concentration at 1 minute as compared with IM epinephrine (0.3 mg) (1.68 ± 0.65 ng/mL vs 0.21 ± 0.08 ng/mL, P = .03). There were no significant differences in Cmax, Tmax, and AUC0–90 between 2‐mg IN and 0.15‐mg IM epinephrine or between 5‐mg IN and 0.3‐mg IM epinephrine. IN epinephrine reduced heart rate increases, as compared to IM epinephrine. IN and IM epinephrine were both well‐tolerated. Overall, IN epinephrine demonstrated advantages over IM epinephrine, including the rapid increase in plasma epinephrine and lack of increased heart rate over time.

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“…IN epinephrine may offer convenience with its small size, ease of carrying, safety, and noninvasiveness as compared with the autoinjector [15]. A treatment method like IN delivery that is easier and more convenient may lead to increased compliance and prompt epinephrine administration in patients during severe allergy or anaphylaxis [12].…”

Section: Discussionmentioning

confidence: 99%

“…In children, there is an increased risk of intraosseous administration and muscle laceration with autoinjector use [8,11]. Lack of portability is also a concern, and patients prescribed autoinjectors do not always carry them [12,13]. Understanding patients' perspectives on carrying frequency, confidence in use, and training experiences may impact the likelihood of a patient having his or her medication on hand in the event of an anaphylactic emergency [12].…”

Section: Introductionmentioning

confidence: 99%

Intranasal epinephrine effects on epinephrine pharmacokinetics and heart rate in a nasal congestion canine model

et al. 2020

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Background: Histamine release and vasodilation during an allergic reaction can alter the pharmacokinetics of drugs administered via the intranasal (IN) route. The current study evaluated the effects of histamine-induced nasal congestion on epinephrine pharmacokinetics and heart rate changes after IN epinephrine. Methods: Dogs received 5% histamine or saline IN followed by 4 mg epinephrine IN. Nasal restriction pressure, epinephrine concentration, and heart rate were assessed. Maximum concentration (C max), area under plasma concentration-time curve from 1 to 90 min (AUC 1-90), and time to reach C max (T max) were measured. Clinical observations were documented. Results: In the 12 dogs in this study, nasal congestion occurred at 5-10 min after IN histamine administration versus no nasal congestion after IN saline. After administration of IN epinephrine, IN histamine-mediated nasal congestion was significantly reduced to baseline levels at 60, 80, and 100 min. There were no significant differences in C max and AUC 1-90 between histamine and saline groups after IN epinephrine delivery (3.5 vs 1.7 ng/mL, p = 0.06, and 117 vs 59 ng/ mL*minutes, p = 0.09, respectively). After receiving IN epinephrine, the histamine group had a significantly lower T max versus the saline group (6 vs 70 min, respectively; p = 0.02). Following IN epinephrine administration, the histamine group showed rapidly increased heart rate at 5 min, while there was a delayed increase in heart rate (occurring 30-60 min after administration) in the saline group. Clinical observations included salivation and emesis. Conclusion: IN histamine led to more rapid epinephrine absorption and immediately increased heart rate compared with IN saline. IN epinephrine decreased histamine-induced nasal congestion.

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Patient Carrying Time, Confidence, and Training with Epinephrine Autoinjectors: The RACE Survey

Cited by 18 publications

References 35 publications

Update on food allergy

Update on food allergy

Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects

Intranasal epinephrine effects on epinephrine pharmacokinetics and heart rate in a nasal congestion canine model

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