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.
Participants (N = 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 United Kingdom. The mean age of participants was 8 years, and approximately half had coexistent asthma.
Subjects had been given an allergy management plan by an allergy physician and/or nurse instructing them when adrenaline should be administered. They were trained in administration with an appropriate trainer device. Participants completed a questionnaire for demographic data, atopic status, and details of allergic reactions.
Overall, 466 participants (48.1%) experienced an allergic reaction in the previous year. A total of 97 (10.1%), 41 (4.3%), 28 (2.9%), and 59 (6.2%) had experienced 2, 3, 4, or more than 4 reactions, respectively. The most common triggers were peanuts, tree nuts, egg, milk, shellfish, seafood, or fruits. Of 245 subjects experiencing anaphylaxis, only 41 (16.7%) received adrenaline. Of the participants who had reactions that did not meet the study definition of anaphylaxis, 6 (2.7%) used their adrenaline. Only 15.3% of participants with wheeze used their autoinjector. Of the 41 participants who experienced anaphylaxis and used their autoinjector, 13 (32%) received more than 1 dose of adrenaline. Of the 204 participants who did not use their adrenaline autoinjector, the most common reasons given for the lack of use were that they thought it was unnecessary (54.4%) or were unsure whether it was necessary (19.1%).
This study found that adrenaline autoinjector use is still widely underused. The study also found that 32% of those who used their autoinjector received a second dose.
This study is alarming in that despite the use of emergency management plans and the use of autoinjector training devices in clinic, adrenaline is still widely underused by patients experiencing anaphylaxis. This has been a long-standing problem in our field, and we need to consider new options on how patient training and support can be improved. One such option may be an educational curriculum for parents designed by the Consortium of Food Allergy Research, available free of charge on their Web site (http://www.cofargroup.org/), that showed improved technique of using epinephrine autoinjectors, increased comfort with treatment, fewer reactions, and improvement in knowledge about food allergy (J Pediatr. 2012;160:651–656). This article also supports the notion that patients should carry a second adrenaline autoinjector, as almost one-third of patients who used their autoinjectors for anaphylaxis required a second dose.
- Copyright © 2012 by the American Academy of Pediatrics