Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement

Cohen, Michael B.; Saunders, Stefanie; Wise, Sarah K.; Nassif, Samih; Platt, Michael P.

doi:10.1002/alr.21884

Cited by 24 publications

(21 citation statements)

References 69 publications

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“…However, carrying a pen was perceived inconvenient and troublesome by most patients. In a study on pitfalls in the use of epinephrine for anaphylaxis, the lack of epinephrine autoinjector availability was the most common problem [27]. Furthermore, inadequate education of patients or providers and uncertainty about the administration were reported complications [27].…”

Section: Discussionmentioning

confidence: 99%

“…In a study on pitfalls in the use of epinephrine for anaphylaxis, the lack of epinephrine autoinjector availability was the most common problem [27]. Furthermore, inadequate education of patients or providers and uncertainty about the administration were reported complications [27]. Thus, not only incompliance in carrying the medication but also a lack of knowledge on how to use the medication should be considered.…”

Section: Discussionmentioning

confidence: 99%

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Disease Burden, Psychological Well-Being and Attitudes regarding the Set of Emergency Medication in Adults with Insect Venom Allergy

Schaarschmidt

Gutknecht

Schoeben

et al. 2018

Int Arch Allergy Immunol

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Background: Insect venom allergy is common and greatly impairs patients’ quality of life. Additionally, low compliance with carrying emergency medication is reported. The aim of our study was to analyze the disease burden, levels of anxiety and depression, and to evaluate attitudes towards the set of emergency medication in affected patients. Methods: Between April 2016 and January 2017, patients ≥18 years visiting our department because of an insect venom allergy were asked to complete a paper-based questionnaire. The questionnaire assessed willingness to pay (WTP), the Hospital Anxiety and Depression Scale (HADS), subjective anxiety levels, willingness to carry the set of emergency medication, self-assurance in using it, compliance with carrying it, and reasons for not always carrying it. Results: 55 patients (81.8% wasp allergy) were included. On average, WTP for a complete cure was EUR 1,727 (median: 500). Using the HADS, 14.5% showed definite anxiety disorders while 5.5% had significant depression disorders. Most patients stated to carry the emergency medication “always” (25.5%) or “almost always” (47.3%). “Forgetfulness” (36.4%) was reported as the main reason for not always carrying the medication, followed by “too big” (18.2%). Conclusions: In our patient cohort, insect venom allergy was associated with a moderate disease burden and a good compliance with carrying the emergency medication. However, several of our participants demonstrated borderline or significant anxiety and/or depression disorders. In this regard, this study highlights the necessity to regularly ask the patient about the psychological well-being to identify patients needing psychological support.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Disease Burden, Psychological Well-Being and Attitudes regarding the Set of Emergency Medication in Adults with Insect Venom Allergy

Schaarschmidt

Gutknecht

Schoeben

et al. 2018

Int Arch Allergy Immunol

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“…Autoinjectors are effective in reducing anaphylactic symptoms; however, they are associated with several patient concerns and are often underused 7‐9 . Patients and caregivers may lack confidence with autoinjectors, which can contribute to anxiety and impede autoinjector use 10‐12 . In addition, there is potential for injuries associated with accidental injections and lacerations at the injection site, as well as the administration of expired autoinjector epinephrine 5,7,9,13,14 .…”

Section: Introductionmentioning

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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“…Patients and clinicians report treatment-related, psychological, and organisational barriers to AAI adherence. 11,[30][31][32][33] A diagnosis of anaphylaxis can have psychosocial consequences that act as barriers to self-care behaviours, including effective use of AAIs. 22 Patients do not routinely update their AAI prescription, 34 and their carriage and use of AAIs is often poor.…”

Section: Introductionmentioning

confidence: 99%

Improving adrenaline autoinjector adherence: A psychologically informed training for healthcare professionals

Mahoney

Walklet

Bradley

et al. 2019

Immunity Inflam & Disease

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Background Clinicians draw on instructional approaches when training patients with anaphylaxis to use adrenaline autoinjectors, but patient use is poor. Psychological barriers to these behaviours exist but are not considered routinely when training patients to use autoinjectors. Health Psychology principles suggest exploring these factors with patients could improve their autoinjector use. Objective To evaluate the impact of a 90‐minute workshop training clinicians in strategies and techniques for exploring and responding to psychological barriers to autoinjector use with patients. Attendees’ knowledge, confidence and likelihood of using the strategies were expected to improve. Methods Impact was evaluated using a longitudinal mixed‐method design. Twenty‐nine clinicians (general and specialist nurses, general practitioners, and pharmacists) supporting patients with anaphylaxis in UK hospitals and general practice attended. Self‐rated knowledge, confidence, and likelihood of using the strategies taught were evaluated online 1 week before, 1 to 3, and 6 to 8 weeks after the workshop. Clinicians were invited for telephone interview after attending to explore qualitatively the workshop impact. Results χ2 analyses were significant in most cases (P < .05), with sustained (6‐8 weeks) improvements in knowledge, confidence, and likelihood of using the strategies taught. Thematic analysis of interview data showed the workshop enhanced attendees’ knowledge of the care pathway, understanding of patient's experience of anaphylaxis as psychological not purely physical, and altered their communication with this and other patient groups. However, interviewees perceived lack of time and organisational factors as barriers to using the strategies and techniques taught in clinical contexts. Conclusion Training clinicians in psychologically informed strategies produce sustained improvements in their confidence and knowledge around patient autoinjector education, and their likelihood of using strategies in clinical practice. Clinical Relevance Exploring psychological barriers should be part of training patients with anaphylaxis in autoinjector use.

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Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement

Cited by 24 publications

References 69 publications

Disease Burden, Psychological Well-Being and Attitudes regarding the Set of Emergency Medication in Adults with Insect Venom Allergy

Disease Burden, Psychological Well-Being and Attitudes regarding the Set of Emergency Medication in Adults with Insect Venom Allergy

Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects

Improving adrenaline autoinjector adherence: A psychologically informed training for healthcare professionals

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