The use of adrenaline autoinjectors by children and teenagers

Abstract

STUDY POPULATION. Data were analyzed from the anaphy-laxis registry of German-speaking countries, which included 197 reported anaphylactic reactions from children and adolescents between 2006 and 2009. This database is based on an online questionnaire for providers of allergy specialty care in Germany, Austria, and Switzerland. METHODS. The questionnaire included demographic data, clinical symptoms, the cause of reaction, accompanying or possible aggravating factors, history of previous reaction , and treatment. To focus on reactions that involved life-threatening symptoms, only children who experienced reactions with at least 1 pulmonary or cardio-vascular symptom were included in the analysis. RESULTS. The most frequently affected organ systems involved in anaphylaxis cases of children and adolescents were the skin (89%) and respiratory tract (87%). Car-diovascular (47%) and gastrointestinal manifestations (43%) were noted less frequently. The most common triggering allergens were foods (58% of cases), followed by insect venoms (24%) and drugs (8%). Peanut was the most frequent food allergen provoking anaphylaxis, followed by tree nuts, cow's milk, and egg. Accompanying or aggravating factors, such as exercise, drug use, coexisting infection, psychological stress, and menses, were noted in 18% of all cases. Only 26% had a history of a previous reaction. Treatment data demonstrated that antihistamines were given 87% of the time and corticosteroids were given 85% of the time, but epi-nephrine was given only 22% of the time. CONCLUSIONS. Use of registry data can provide insight into the features of children presenting with anaphylaxis. Food allergens were the most common triggers for anaphylaxis and possible aggravating factors were noted in nearly 1 in 5 cases, with exercise being the most common. The low frequency of epinephrine administration suggests ongoing need for education for both families and physicians. REVIEWER COMMENTS. This study aimed to characterize children with life-threatening anaphylactic reactions by selecting those with cardiovascular and/or pulmonary involvement. Consistent with other studies, food aller-gens (most commonly peanut) were the most frequent trigger for reaction. The rate of accompanying or aggravating factors suggests that these should be considered in evaluation of all children with anaphylaxis. The low rate of epinephrine use is concerning, especially given that this study focused on more severe reactions, although this is consistent with most other studies of anaphylaxis from around the world. et al. Clin Exp Allergy. 2011;42(2):284-292 PURPOSE OF THE STUDY. To evaluate the rate at which adrenaline autoinjectors are used during anaphylactic reactions by patients who have had them prescribed, and to assess the number of devices used for each reaction. STUDY POPULATION. Participants (N 5 969) were children and teenagers aged 18 years or less who had been prescribed an adrenaline autoinjector for at least 1 year, recruited from 14 pediatric allergy clinics throughout the Unite...

EAACI Food Allergy and Anaphylaxis Guidelines: managing patients with food allergy in the community

“…However, an alarming under-prescription of AAI was reported in school-going adolescents: Although the autoinjector was indicated in 3.0%, only 0.09% of the adolescent evaluated owned a device (39). In a study of children from 14 allergy clinics throughout UK, only 16.7% used their prescribed AAI during anaphylaxis (40). These data emphasize the importance of repeated education and assessment of the knowledge on how and when to use of AAI devices (37).…”

Kurzdarstellung

“…Ausgebildete Ersthelfer können bei dieser Maßnah-me unterstützen. Geben Sie allen Personen mit einer Anaphylaxie im präklini-schen Bereich eine zweite intramuskuläre Adrenalindosis, wenn sich die Symptome innerhalb von 5-15 min nach der Anwendung eines intramuskulären AdrenalinAutoinjektors nicht gebessert haben [843][844][845][846][847][848][849][850][851][852]. Auch bei einem Wiederauftreten der Symptome kann eine zweite intramuskuläre Dosis Adrenalin notwendig sein.…”

Actualización en las recomendaciones del tratamiento del choque anafiláctico: novedades sobre el uso de adrenalina

“…Esta revisión destaca las problemáticas que pueden existir entre las distintas poblaciones estudiadas, sobre todo las dificultades que se encuentran en los adolescentes. 41 Algunos pacientes pueden requerir una segunda dosis de adrenalina durante el rescate dependiendo del origen de la anafilaxia [42][43][44][45][46] y, en ciertas oportunidades, se debe indicar la provisión de dos dosis de autoinyectores. 47 Aunque, en las reacciones graves, el uso de adrenalina podría disminuir notoriamente los costos directos relacionados con la anafilaxia por disminución de internaciones y de tratamientos más extremos, en las reacciones leves por picaduras de insectos, no ha demostrado una efectividad relevante relacionada con el costo-beneficio.…”