Timing the transfer of responsibilities for anaphylaxis recognition and use of an epinephrine auto-injector from adults to children and teenagers: pediatric allergists' perspective

Simons, Elinor; Sicherer, Scott H.; Simons, F. Estelle R.

doi:10.1016/j.anai.2012.03.004

Cited by 35 publications

(19 citation statements)

References 23 publications

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“…They started to train early and individualized the time of transfer on the basis of patient factors, such as the presence of asthma and absence of cognitive dysfunction. 55 In contrast, caregivers of at-risk children and teenagers who were surveyed expected to begin transfer of responsibilities considerably earlier, by 6 to 11 years of age. 56 In both of these studies, the investigators commented that 6.…”

Section: Using Easmentioning

confidence: 99%

Epinephrine for First-aid Management of Anaphylaxis

2017

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Anaphylaxis is a severe, generalized allergic or hypersensitivity reaction that is rapid in onset and may cause death. Epinephrine (adrenaline) can be life-saving when administered as rapidly as possible once anaphylaxis is recognized. This clinical report from the American Academy of Pediatrics is an update of the 2007 clinical report on this topic. It provides information to help clinicians identify patients at risk of anaphylaxis and new information about epinephrine and epinephrine autoinjectors (EAs). The report also highlights the importance of patient and family education about the recognition and management of anaphylaxis in the community. Key points emphasized include the following: (1) validated clinical criteria are available to facilitate prompt diagnosis of anaphylaxis; (2) prompt intramuscular epinephrine injection in the mid-outer thigh reduces hospitalizations, morbidity, and mortality; (3) prescribing EAs facilitates timely epinephrine injection in community settings for patients with a history of anaphylaxis and, if specifi c circumstances warrant, for some high-risk patients who have not previously experienced anaphylaxis; (4) prescribing epinephrine for infants and young children weighing <15 kg, especially those who weigh 7.5 kg and under, currently presents a dilemma, because the lowest dose available in EAs, 0.15 mg, is a high dose for many infants and some young children; (5) effective management of anaphylaxis in the community requires a comprehensive approach involving children, families, preschools, schools, camps, and sports organizations; and (6) prevention of anaphylaxis recurrences involves confi rmation of the trigger, discussion of specifi c allergen avoidance, allergen immunotherapy (eg, with stinging insect venom, if relevant), and a written, personalized anaphylaxis emergency action plan; and (7) the management of anaphylaxis also involves education of children and supervising adults about anaphylaxis recognition and fi rst-aid treatment.

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Section: Using Easmentioning

confidence: 99%

Epinephrine for First-aid Management of Anaphylaxis

2017

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“…The allergists individualized the timing of transfer based on patient factors such as presence of asthma and absence of cognitive dysfunction [69]. Caregivers of children and teenagers at increased risk of anaphylaxis in community settings expected to begin gradual transfer of responsibilities earlier, to children age <6-11 years [70].…”

Section: Long-term Management: Self-treatment In Community Settingsmentioning

confidence: 99%

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Simons

Ardusso

Dimov

et al. 2013

Int Arch Allergy Immunol

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The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis are a widely disseminated and used resource for information about anaphylaxis. They focus on patients at risk, triggers, clinical diagnosis, treatment in health care settings, self-treatment in the community, and prevention of recurrences. Their unique strengths include a global perspective informed by prior research on the global availability of essentials for anaphylaxis assessment and management and a global agenda for anaphylaxis research. Additionally, detailed colored illustrations are linked to key concepts in the text [Simons et al.: J Allergy Clin Immunol 2011;127:593.e1-e22]. The recommendations in the original WAO Anaphylaxis Guidelines for management of anaphylaxis in health care settings and community settings were based on evidence published in peer-reviewed, indexed medical journals to the end of 2010. These recommendations remain unchanged and clinically relevant. An update of the evidence base was published in 2012 [Simons et al.: Curr Opin Allergy Clin Immunol 2012;12:389-399]. In 2012 and early 2013, major advances were reported in the following areas: further characterization of patient phenotypes; development of in vitro tests (for some allergens) that help distinguish clinical risk of anaphylaxis from asymptomatic sensitization; epinephrine (adrenaline) research, including studies of a new epinephrine auto-injector for use in community settings, and randomized controlled trials of immunotherapy to prevent food-induced anaphylaxis. Despite these advances, the need for additional prospective studies, including randomized controlled trials of interventions in anaphylaxis is increasingly apparent. This 2013 Update highlights publications from 2012 and 2013 that further contribute to the evidence base for the recommendations made in the original WAO Anaphylaxis Guidelines. Ideally, it should be used in conjunction with these Guidelines and with the 2012 Guidelines Update.

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“…Although no specific guidelines exist to determine when it would be appropriate for a child to self-carry and/or self-administer epinephrine autoinjectors, a survey of members of the AAP Section on Allergy and Immunology found that most pediatric allergy specialists begin to expect children 9 through 11 years of age to be able to recognize signs and symptoms of anaphylaxis and expect children 12 through 14 years of age to self-carry epinephrine autoinjectors and self-administer the device. 11 In a study of family and nonfamily caregivers of children with food allergy, most expected the child to be able to recognize anaphylaxis at approximately 6 through 8 years of age and believed that epinephrine autoinjector use was appropriate for children 6 through 11 years of age. 15 Thus, these decisions may benefit from personalization with the input of the family.…”

Section: Demographic Information and Allergy Historymentioning

confidence: 99%

“…A survey of AAP Section on Allergy and Immunology members found that there is wide variation in terms of which plans are used by pediatric allergy specialists. 11 Therefore, a universal plan for pediatric patients could be beneficial to patients, families, health care professionals, and schools to facilitate care for children at risk of anaphylaxis. The AAP Allergy and Anaphylaxis Emergency Plan associated with this clinical report was developed with the support and advice of various committees, councils, and sections within the AAP.…”

Section: Introductionmentioning

confidence: 99%

Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan

Wang¹,

Sicherer

Allergy

2017

Pediatrics

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Anaphylaxis is a potentially life-threatening, severe allergic reaction. The immediate assessment of patients having an allergic reaction and prompt administration of epinephrine, if criteria for anaphylaxis are met, promote optimal outcomes. National and international guidelines for the management of anaphylaxis, including those for management of allergic reactions at school, as well as several clinical reports from the American Academy of Pediatrics, recommend the provision of written emergency action plans to those at risk of anaphylaxis, in addition to the prescription of epinephrine autoinjectors. This clinical report provides information to help health care providers understand the role of a written, personalized allergy and anaphylaxis emergency plan to enhance the care of children at risk of allergic reactions, including anaphylaxis. This report offers a comprehensive written plan, with advice on individualizing instructions to suit specifi c patient circumstances.

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Timing the transfer of responsibilities for anaphylaxis recognition and use of an epinephrine auto-injector from adults to children and teenagers: pediatric allergists' perspective

Cited by 35 publications

References 23 publications

Epinephrine for First-aid Management of Anaphylaxis

Epinephrine for First-aid Management of Anaphylaxis

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan

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