Autoinjector Prescription Research Articles

An International Delphi Consensus on the Management of Pollen–Food-Allergy Syndrome: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee

Pollen-food-allergy syndrome (PFAS) is common among patients with allergic rhinitis. Treatment recommendations for patients with PFAS remain variable. To develop consensus recommendation statements for managing patients with PFAS. An international panel of allergists, researchers, and nutritionists with an interest in PFAS from 25 different institutions across 11 countries convened and a list of statements was written by 3 authors. The RAND/University of California Los Angeles methodology was adopted to establish consensus on the statements. After 2 Delphi rounds, a consensus was reached on 14 statements. The panel agreed that patients with PFAS would benefit from counseling on the nature and basis of PFAS and the rare chance of more severe systemic reactions and their recognition. The panel agreed on avoiding the raw food responsible for the index reaction, but not potentially cross-reactive fruits/vegetables based on the responsible food of the index reaction. Epinephrine autoinjectors should be recommended for patients with PFAS who experienced severe symptoms (beyond the oropharynx) or for patients considered at risk for severe reactions. The panel agreed that the benefit of allergen immunotherapy remains unclear and that PFAS should not be considered the primary indication for such intervention. We developed consensus statements regarding counselling patients about the nature and severity of PFAS, potential risk factors, dietary avoidance, epinephrine autoinjector prescription, and allergen immunotherapy consideration for patients with PFAS.

Time trends in the epidemiology of food allergy in England: an observational analysis of Clinical Practice Research Datalink data

Estimates for the prevalence of food allergy vary widely, with a paucity of data for adults. The aim of this analysis was to report trends in the incidence and prevalence of food allergy in England, using a national primary care dataset. We analysed data from Clinical Practice Research Datalink between 1998 and 2018, with linked data to relevant hospital encounters in England. The main outcomes were incidence and prevalence of food allergy, according to three definitions of food allergy: possible food allergy, probable food allergy, and probable food allergy with adrenaline autoinjectors prescription. We also evaluated the difference in proportion of patients prescribed adrenaline autoinjectors by English Index of Multiple Deprivation (IMD), age, and by previous food anaphylaxis, and explored differences in patient encounters (general practice vs emergency department setting). 7 627 607 individuals in the dataset were eligible for inclusion, of whom 150 018 (median age 19 years [IQR 4-34]; 82 614 [55·1%] female and 67 404 [44·9%] male) had a possible food allergy. 121 706 met diagnostic criteria for probable food allergy, of whom 38 288 were prescribed adrenaline autoinjectors. Estimated incidence of probable food allergy doubled between 2008 and 2018, from 75·8 individuals per 100 000 person-years (95% CI 73·7-77·9) in 2008 to 159·5 (156·6-162·3) individuals per 100 000 person-years in 2018. Prevalence increased from 0·4% (23 399 of 6 432 383) to 1·1% (82 262 of 7 627 607) over the same period and was highest in children under 5 years (11 951 [4·0%] of 296 406 in 2018) with lower prevalence in school-aged children (from 11 353 [2·4%] of 473 597 in 2018 for children aged 5-9 years to 6896 [1·7%] of 404 525 for those aged 15-19 years) and adults (42 848 [0·7%] of 5 992 454 in 2018). In those with previous food anaphylaxis, only 2321 (58·3%) of 3980 (975 [64·0%] of 1524 children and young people and 1346 [54·8%] of 2456 adults) had a prescription for adrenaline autoinjector. Adrenaline autoinjectors prescription was less common in those resident in more deprived areas (according to IMD). In the analysis of health-care encounters, 488 604 (97·1%) of 503 198 visits recorded for food allergy occurred in primary care, with 115 655 (88·4%) of 130 832 patients managed exclusively in primary care. These estimates indicate an important and increasing burden of food allergy in England. Our findings that most patients with food allergy are managed outside the hospital system, with low rates of adrenaline autoinjector prescription in those with previous anaphylaxis, highlight a need to better support those working in primary care to ensure optimal management of patients with food allergy. UK Food Standards Agency and UK Medical Research Council.

Valoración de la eficacia de la educación en el manejo de autoinyectores de adrenalina

Introduction: anaphylaxis is a medical emergency and early administration of adrenaline is essential to reduce morbidity and mortality. Adrenaline autoinjectors are available for patients with a diagnosis of anaphylaxis so they can receive the medication without delay. The main goal of our study was to evaluate parental knowledge about anaphylaxis and the use of autoinjectors and whether their knowledge improved after some training. Material and methods: pre- and post-intervention study. We analysed 6 primary care caseloads, selecting patients with a diagnosis of anaphylaxis who had adrenaline autoinjector prescriptions. Participants received 2 emails. The first one included a questionnaire about anaphylaxis and how to use the adrenaline autoinjector. The second one contained informational pages and videos and a second questionnaire. That way we compared parental knowledge before and after receiving some training. Results: food was the main cause of anaphylaxis. Only 56.3% of the participants carried the autoinjector at all times. Comparing the knowledge before and after the intervention, we found improvement in nearly every step of the administration of adrenaline. The improvement was statistically significant when it came to the correct identification of the safety release cap (p 0.018) and the awareness of the possibility of administering a second dose (p 0.006). There was a clear improvement in the knowledge of needing to massage the injection area, but it was not statistically significant (p 0.066) Conclusions: periodic training about how to use the autoinjectors is key to reduce morbidity and mortality in patients with anaphylaxis.

Clinical spectrum of patients diagnosed with childhood mastocytosis: a retrospective single center experience.

Background. Pediatric cutaneous mastocytosis patients diagnosed and followed up by our specialist were enrolled in this study, and clinical and laboratory evaluations were retrospectively analyzed from patients' archived files. Methods. Patients, who applied to the Division of Pediatric Allergy And Immunology Unit of a University Training and Research Hospital between 01.01.2010 and 28.04.2021, were enrolled in this study. Results. Of the 33 patients included in the study, 11 (33.3%) were female and 22 (67.7%) were male. The median age of onset of the patient's complaints was 7 (0-60) months. The median age at diagnosis was 11 (2-64) months. Their complaints' median regression age was 54 (6-192) months. Resistant clinical findings were followed in 13 (39.4%) patients. Itching, redness, gastrointestinal symptoms, and maculopapular eruption were the most common complaints. The rashes were mostly polymorphic and larger than 1 cm. Heat was the most common trigger. Darier's sign was positive in 97% of the patients. Antihistamines were the most commonly used drug for prophylaxis and treatment. The autoinjector prescription rate was 24.2%. Conclusions. Quality of life was mildly affected in 48,5% of the patients based on the CDLQI scores. Thus, patients should be followed up through adolescence for the development of systemic signs and symptoms.

Detecting epinephrine auto-injector shortages in Finland 2016-2022: Log-data analysis of online information seeking.

Medicine shortages prevail as a worldwide problem causing life-threatening situations for adults and children. Epinephrine auto-injectors are used for serious allergic reactions called anaphylaxis, and alternative auto-injectors are not always available in pharmacies. Healthcare professionals in Finland use the dedicated internet source, Physician's Database (PD), when seeking medical information in practice, while Health Library (HL) provides health information for citizens (S1 Data). The objectives were to assess whether (1) professionals' searches for epinephrine auto-injectors and (2) citizens' anaphylaxis article openings relate to epinephrine shortages in Finland. Monthly log data on epinephrine auto-injectors (EpiPen®, Jext®, Emerade®) from PD and on openings of anaphylaxis articles from HL were collected during 2016-2022. Professionals' searches of seven auto-injectors and citizens' openings of four anaphylaxis articles were compared to information on epinephrine shortages reported by Finnish Medicines Agency. Professionals' auto-injector prescriptions provided by Social Insurance Institution were also assessed. Total searches in EpiPen® (N = 111,740), Jext® (N = 25,631), and Emerade® (N = 18,329) could be analyzed during 2016-2022. EpiPen® only could visually show seasonal patterns during summertime, peaking vigorously in the summer of 2018 when the major EpiPen® shortage appeared worldwide. Anaphylaxis articles equaled 2,030,855 openings altogether. Openings of one anaphylaxis article ("Bites and Stings") peaked during summertime, while another article ("Anaphylactic Reaction") peaked only once (three-fold increase) at the end of 2020 when COVID-19 vaccinations started, and auto-injector prescriptions were lowest. Fifty EpiPen®, one Jext®, and twelve Emerade® shortages were reported. Almost a two-fold increase in peaks of auto-injector prescriptions was found during summertime. This study shows that (1) epinephrine shortages related to professionals' searching for auto-injectors, and (2) citizens' information seeking on anaphylaxis related to summertime and shortages with lesser prescriptions. Therefore, the dedicated internet databases aimed at professionals and citizens could be used as additional information sources to detect anaphylactic reactions and auto-injector shortages.

Health disparities in hymenoptera venom allergy management.

Background: Hymenoptera venom anaphylaxis (HVA) is reported in up to 3% of stings and accounts for approximately 40 US deaths annually. HVA patients require immediate availability of epinephrine and Allergist referrals for consideration of venom immunotherapy. Data regarding epinephrine autoinjector prescriptions, Allergist referral rates, and potential racial disparities are limited. Objective: The primary objective was to determine if there were statistically significant differences in epinephrine autoinjector prescriptions and Allergist referrals between white and African American patients. The secondary objectives were to determine if there were statistically significant differences between adult and pediatric patients and to determine if there were significant differences between epinephrine prescriptions between patients with and without Allergist referrals. Method: This study is a retrospective, descriptive chart review analyzing patients seen between January 01, 2019 and December 31, 2021. Data were obtained utilizing the Epic Systems (Verona, WI) application Slicer Dicer. Individual chart review was performed for age, race, epinephrine autoinjector prescription, and Allergist referral. Results: 342 patients were identified as having HVA. White patients (60 out of 219; 27.4%) were more likely to get epinephrine autoinjector prescriptions than African American patients (17 out of 109; 15.6%) (p = 0.018). Adult patients (25 out of 314; 8.0%) were less likely than pediatric patients (8 out of 28; 28.6%) to have Allergist referrals (p = 0.004). Patients with Allergist referrals (25 out of 32; 78.1%) were more likely to be prescribed an epinephrine autoinjector than patient without Allergist referrals (54 out of 310; 17.4%) (p < 0.00001). Conclusion: Epinephrine autoinjector prescriptions and Allergist referrals are low overall in HVA. Racial disparities were identified with African American patients being significantly less likely to receive epinephrine autoinjector prescriptions. Additionally, adult patients, who may be at increased risk, were less likely to receive Allergist referrals.

Anaphylaxis management in a French pediatric emergency department: Lessons from the ANA-PED study.

Anaphylaxis is a serious systemic hypersensitivity reaction that requires immediate recognition and prompt administration of epinephrine/adrenaline. The present study aimed to assess the appropriateness of epinephrine/adrenaline use in children identified as allergic by physicians in the emergency department (ED) at the time of the reaction, and to identify factors that are possibly associated with epinephrine/adrenaline administration, auto-injector prescription, and further referral to an allergist. We performed a retrospective cross-sectional study at the pediatric ED of the University Hospital of Montpellier, France. We included all consecutive children who attended the ED between 2016 and 2020 with an allergy-related diagnosis at discharge. We included 1056 allergy-related visits, including 224 (21.2%) with a diagnosis of anaphylaxis at discharge; only 17.0% of them received an epinephrine/adrenaline injection, and 57.1% consulted an allergist after the acute episode. An auto-injector was prescribed to 63 (28.1%) patients at discharge from the ED. Besides the severity of the clinical presentation, factors associated with a guidelines-based management of the anaphylactic reaction and with an increased administration rate of epinephrine/adrenaline included presence of asthma symptoms and presence of extended skin reactions. Our study underlines persistent gaps in the management of pediatric anaphylaxis in ED, focusing on hereby identified levers. By disseminating current knowledge and guidelines on anaphylaxis and allergies, specialists could work together with emergency physicians to establish effective management algorithms and improve anaphylaxis management and care pathways for children experiencing allergic reactions, especially anaphylaxis. Clinical Trials, number NCT05112367.

Healthcare Disparities In Hymenoptera Venom Allergy Management

Hymenoptera venom anaphylaxis (HVA) is reported in 0.3-3% of stings and accounts for approximately 40 US deaths annually. HVA patients require immediate availability of epinephrine and Allergist referrals for consideration of venom immunotherapy. Data regarding epinephrine autoinjector prescriptions, Allergist referral rates, and potential racial disparities are limited.

Identifying Modifiable Predictors of COVID-19 Vaccine Side Effects: A Machine Learning Approach.

Side effects of COVID-19 or other vaccinations may affect an individual’s safety, ability to work or care for self or others, and/or willingness to be vaccinated. Identifying modifiable factors that influence these side effects may increase the number of people vaccinated. In this observational study, data were from individuals who received an mRNA COVID-19 vaccine between December 2020 and April 2021 and responded to at least one post-vaccination symptoms survey that was sent daily for three days after each vaccination. We excluded those with a COVID-19 diagnosis or positive SARS-CoV2 test within one week after their vaccination because of the overlap of symptoms. We used machine learning techniques to analyze the data after the first vaccination. Data from 50,484 individuals (73% female, 18 to 95 years old) were included in the primary analysis. Demographics, history of an epinephrine autoinjector prescription, allergy history category (e.g., food, vaccine, medication, insect sting, seasonal), prior COVID-19 diagnosis or positive test, and vaccine manufacturer were identified as factors associated with allergic and non-allergic side effects; vaccination time 6:00–10:59 was associated with more non-allergic side effects. Randomized controlled trials should be conducted to quantify the relative effect of modifiable factors, such as time of vaccination.

Real World Management of Anaphylaxis Versus the National Institute for Health and Clinical Excellence (NICE) Guidelines.

Objectives Anaphylaxis is an acute, life-threatening immediate allergic reaction caused by the sudden systemic release of mediators from mast cells. This study aims to assess the current practice of emergency management of children and adults diagnosed with anaphylaxis at the Royal Hospital, Muscat, Oman, in line with the National Institute for Health and Clinical Excellence (NICE) guidelines. MethodsThis is an observational retrospective study of all anaphylaxis cases seen at the emergency department (ED) from January 2013 to January 2018 and compared with the management of anaphylaxis in the ED as per the NICE guidelines. Inclusion criteria were all patients, children (age 16 and below), and adults diagnosed with anaphylaxis based on the World Allergy Organization (WAO) criteria. Exclusion criteria are all cases labeled as anaphylaxis that did not match the WAO criteria for anaphylaxis.ResultsOf 100 patients with a preliminary diagnosis of anaphylaxis, 49 patients (49%) were true-anaphylaxis cases based on the WAO definition 16 were children (age 16 years and below), and 33 were adults ( age 16 years and above). The other 51 patients (51%) with misdiagnosed anaphylaxis were later diagnosed with spontaneous urticaria, septic shock, vocal cord dysfunction, severe asthma, and anxiety attack. All 49 patients with true-anaphylaxis appropriately received adrenaline intramuscularly at the ED. All 16 children were admitted, seen by an allergist, and received an adrenaline auto-injector when indicated. Only 5 of the 33 adults were admitted and seen by an allergist, and 4 of those required an adrenaline auto-injector upon discharge. The remaining 28 adults were discharged from the ED, and only 3 of these were referred to the allergist. None received an adrenaline auto-injector upon discharge from the ED, and no mention in the ED notes on patient education regarding allergen avoidance.ConclusionThird of the patients who presented to ED were children (<16 years), and two third were adults. Insect venom was the main reason for anaphylaxis in both age groups. There was an underutilization of adrenaline auto-injector prescriptions for adult patients. This could be very well improved by disseminating policies and guidelines to adult physicians.

Epinephrine Auto-Injector Prescription and Use: A Retrospective Analysis and Clinical Risk Assessment of Adult Patients Sensitised to Lipid Transfer Protein

Epinephrine Auto-Injector Prescription and Use: A Retrospective Analysis and Clinical Risk Assessment of Adult Patients Sensitised to Lipid Transfer Protein

Epinephrine Auto-Injector Prescription and Use: A Retrospective Analysis and Clinical Risk Assessment of Adult Patients Sensitised to Lipid Transfer Protein

Epinephrine Auto-Injector Prescription and Use: A Retrospective Analysis and Clinical Risk Assessment of Adult Patients Sensitised to Lipid Transfer Protein

Epinephrine Auto-Injector Prescription and Use: A Retrospective Analysis and Clinical Risk Assessment of Adult Patients Sensitized to Lipid Transfer Protein.

Lipid transfer proteins (LTPs) are widely widespread plant food allergens which represents the main cause of food allergy in adults living in the Mediterranean basin. The purpose of this study was to investigate in LTP patients the actual use of prescribed epinephrine auto-injector and appropriateness of its prescription. In addition, we investigated in these patients: (1) occurrence of new food reaction in the following three years after to diagnosis; (2) need and number of access to emergency services; (3) presence of possible predictive factors to further food reactions. One-hundred sixty-five adult patients sensitized to LTPs have been included. During follow-up, we recorded 68 further reactions, most of them (77.9%) characterized by local symptoms; rarely the patients required an emergency-department visits (16.1%) and only one patient (1.7%) used the epinephrine auto-injector. The patients with a previous history of anaphylaxis at baseline turned back to access to emergency services also during the follow-up (p = 0.006). The majority of patients with recorded systemic reactions (p = 0.004) and treated in an emergency room (p = 0.028) did not have any co-factor-enhanced at diagnosis. We noted an association between platanus pollen sensitization and severity of further reactions during the follow-up (p = 0.026). Epinephrine auto-injector were prescribed to 108/165 patients (65.5%) with an over-prescription rate of 25%. The unforeseeable clinical presentation of LTP allergic reactions and the eventual role played by the cofactor make necessary schedule a follow-up to monitor the patients over time and to assess the actual use of epinephrine auto injectors prescribed.

Emergency department childhood anaphylaxis presentations in regional/remote Australia.

AimExplore the prevalence of childhood anaphylaxis and clinical presentation of anaphylaxis in children across two regional emergency departments over a 7‐year period.MethodsRetrospective audit of all children (0–18 years) presenting to emergency from 1 January 2010 to 31 December 2016 with anaphylaxis, defined by Australasian Society of Clinical Immunology and Allergy definitions and doctor diagnosis.ResultsSeven hundred and twenty‐four patients were identified with allergic diagnosis, 60% were diagnosed with non‐anaphylaxis allergic reactions or unspecified urticaria and 40% with anaphylaxis (n = 286). Annual prevalence of anaphylaxis remained stable over the study period (M = 30.9/10 000 cases, range: 20.8–48.3/10 000). Gender distribution was equal, median age was 9.48 years (interquartile range = 4–15). Most (71%) arrived by private transport. 23% had a prior history of anaphylaxis. Food triggers (44%) were the most common cause of anaphylaxis. Insect bites/stings triggers occurred in 21%. Patients were promptly assessed (average wait time = 13 min), 16% received prior adrenaline injections. Adrenaline was administered in 26% and 20% were admitted to hospital. On discharge, 29% had a follow‐up plan, 9% received an allergy clinic referral, 6% anaphylaxis action plan, 26% adrenaline autoinjector prescriptions and allergy testing performed in 6%.ConclusionsWe found a relatively low prevalence of overall childhood anaphylaxis in a regional area. The two most common causes of anaphylaxis in this population (food and bites/stings) recorded increased prevalence providing an opportunity for further study. Significant gaps in evidence‐based care of anaphylaxis were noted, demonstrating the need for improved recognition and treatment guideline implementation in regional areas.

Evaluation of adrenaline auto-injector prescription profiles: A population-based, retrospective cohort study within the National Insurance Claims Database of Japan

BackgroundAdrenaline is the first-line medication for managing anaphylaxis. A better understanding of prescription trends for adrenaline auto-injectors (AAIs) is important to improving patient care as well as information on health education interventions and medical guidelines. However, it has been difficult to gather comprehensive data in a sustainable manner. Thus, we aimed to investigate trends in AAI prescriptions in Japan. MethodsWe searched the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), a unique and comprehensive database of health insurance claims, and investigated prescriptions for AAIs for all ages (April 2017 to March 2018). We assessed the annual number of prescriptions per person as well as prescription rates per 100,000 population per year by age, sex, and geographic region. ResultsA total of 88,039 subjects (56,109 males, 31,930 female) and 116,758 devices (1.33 AAIs per patient per year) were prescribed AAIs at least once a year for all ages. The prescription rate for AAIs was 69.5 per 100,000 population-years. Patients aged 0–9 years were prescribed AAIs at the rate of 278.9 per 100,000 population-years. Patients aged 0–19 years were 6.4 times more likely to be prescribed AAIs than those over 20 years of age. Males were more frequently prescribed AAIs than females in all age groups, except for those aged 20–24 years. We also evaluated differences in prescription rates by geographic region. ConclusionsThis comprehensive evaluation revealed trends in AAI prescriptions, thus helping develop preventive strategies with respect to anaphylaxis in Japan.

Adrenaline auto-injector prescription profiles and clinical features of adult patients: A study from Malatya Province

Adrenaline auto-injector prescription profiles and clinical features of adult patients: A study from Malatya Province

Food Anaphylaxis in the United Kingdom: Analysis of National Data, 1998–2018

To analyze trends in hospital admissions for food anaphylaxis in the United Kingdom from 1998 to 2018, including case-fatality rates.All patients admitted to hospitals for anaphylaxis in the United Kingdom (England, Scotland, Wales, and Northern Ireland) were studied. Children were identified as age ≤15 years.International Classification of Diseases, 10th Revision, codes were analyzed for all allergy-related admissions with both food-related and non–food-related causes, by using the Hospital Episodes Statistics database via the National Health Services. Fatal food-induced anaphylaxis data has been recorded through the UK’s Fatal Anaphylaxis Registry. Admission data were compared along time trends among different age groups, sex, and inciting triggers. Trends in the national case-fatality rate and epinephrine autoinjector (EAI) prescriptions were also analyzed.Across all age groups, allergy-related hospital admissions increased during the study period from 10 to 28 admissions per 100 000 population per year, at a rate ratio of 1.043 (1.042 to 1.043; P < .001). A total of 255 913 admissions occurred during the 10-year interval, of which 39.8% were due to anaphylaxis. The rate of anaphylaxis-associated admissions increased by 179%, with a rate ratio of 1.047 (1.046 to 1.048; P < .001) and was similar across all age groups. Girls had a higher rate of admission for nonfood anaphylaxis admissions. Boys (age: <15) had a higher rate of admission with food triggers, but this predominance dissipated into adulthood. A total of 30.1% of admissions for anaphylaxis were identified with a food trigger, with an annual rate ratio of 1.057 (1.055 to 1.059; P < .001). The greatest increase was observed in children, from 2.1 to 9.2 admissions per 100 000 or an increase of 339%. Individuals aged 15 to 59 years had an increase of 214%, whereas those aged >60 years had an increase of 78% over the same time interval. Despite a national recommendation in 2016 encouraging admission for children with suspected anaphylaxis, the admission rate for children did not significantly increase. The annual fatality rates from food-induced anaphylaxis were 0.009 and 0.008 per 100c000 population in 1998 and 2018, respectively, but the case-fatality rate had decreased from 0.70% to 0.19% in the same period. The highest rate of fatalities occurred in teenagers. Children <5 years of age were more likely to be admitted for anaphylaxis but had lower rates of death. A total of 46% of fatalities were associated with peanuts or tree nuts. Additionally, the fatality rate associated with cow’s milk increased since 1992, with 26% of deaths in children and 5% in adults caused by cow’s milk exposure. The rates of death from peanuts and tree nuts decreased during this interval. Prescriptions for EAI devices increased by 336% overall or by an 11% increase on a year-by-year basis.From 1998–2018, the number of hospital admissions for anaphylaxis and prescriptions for EAIs in the United Kingdom significantly increased, and the case-fatality rate for anaphylaxis decreased. Peanuts and tree nuts accounted for the greatest portion of fatal reactions, but among children <5 years of age, cow’s milk was the most common trigger.The strengths of this study include the use of 20 years of data and a national database that examined >255 000 admissions. This study also revealed the increasing role of cow’s milk anaphylaxis in food allergy fatalities. This study relied on International Classification of Diseases, 10th Revision, codes. It is possible that the data regarding admissions and fatalities are an underestimate because anaphylaxis and its triggers are often not coded accurately.

Maternal anxiety and previous anaphylaxis are associated with alexithymia in young patients with food allergy.

Alexithymia is a multifaceted personality construct described as "a lack of words to express emotions" that includes difficulty identifying feelings, difficulty describing feelings and a concrete, externally oriented cognitive style. Among patients with food allergy (FA) alexithymia has been found higher than in general population and associated with dysfunctional coping strategies. Childhood traumatic experiences and/or dysfunctional parent-child relationship can contribute to alexithymia. The study aimed to explore possible associations between child alexithymia and mother alexithymia and anxiety, as well as previous anaphylaxis. Sixty-five mother-child pairs have been recruited. Children had a medical diagnosis of FA. The Toronto Alexithymia Scale-20 was used to assess alexithymia in participants. The State-Trait Anxiety Inventory was used to assess trait anxiety in mothers. Statistical analysis was performed to investigate the influence of variables sex, previous anaphylaxis, and adrenaline auto-injector prescription on child and mother's alexithymia and to explore possible association between maternal and child alexithymia. A substantial percentage of children were alexithymic (21.5%) or borderline (33.8%), while mothers' frequencies were lower and in line with prevalence in general population. Child alexithymia was positively associated with previous anaphylaxis and mothers' trait anxiety (p<.05). Mother trait anxiety was also associated with maternal alexithymia. Furthermore, a positive association between child and mother alexithymia has been found. Clinicians must be aware of the role of alexithymia and its association with maternal anxiety and previous anaphylaxis in children with FA, encouraging seeking psychological support when needed. A multidisciplinary patient-centered approach should be put in place for the effective care of FA.

Prevalence, Management, and Anaphylaxis Risk of Cold Urticaria: A Systematic Review and Meta-Analysis

Cold urticaria is a subtype of chronic inducible urticaria (CIndU) associated with significant morbidity and a risk for anaphylaxis. Few studies have assessed the prevalence, management, and prevalence of associated anaphylaxis of cold urticaria. To evaluate the prevalence of cold urticaria among CIndU and chronic urticaria (CU) cases, to assess the management of cold urticaria, and to determine the prevalence of associated anaphylaxis. We searched PubMed and EMBASE for studiespertaining to cold urticaria and/or CIndU published in the past 10 years. We conducted meta-analyses to evaluate theprevalence of cold urticaria among CIndU and CU cases,the management of cold urticaria with H1-antihistamines andomalizumab, and the prevalence of associated anaphylaxis. Twenty-two studies were included in the systematicreview and 14 in the meta-analysis. The pooled prevalence of cold urticaria among patients with CU and CIndU was 7.62% (95% confidence interval [CI], 3.45% to 15.99%; I2=98%) and 26.10% (95% CI, 14.17% to 43.05%; I2= 97%), respectively. Cold urticaria was managed by H1-antihistamines in 95.67% (95% CI, 92.47% to 97.54%; I2= 38%) of patients and omalizumab in 5.95% (95% CI , 2.55% to 13.27%; I2= 83%) of patients. The pooled prevalence of anaphylaxis among patientswith cold urticaria was 21.49% (95% CI, 15.79% to 28.54%; I2= 69%). Cold urticaria constitutes an appreciable proportion of CIndU and CU cases and is predominantly managed with H1-antihistamines; few patients receive omalizumab. Anaphylaxis is common, and an epinephrine autoinjector prescription may be considered.

The Psychosocial Burden of Food Allergy Among Adults: A US Population-Based Study

Food allergy (FA) affects >25 million US adults, resulting in substantial health care utilization. Data suggest that patients with FA suffer impairments in FA-related quality of life (FAQoL); however, little is known regarding psychosocial impacts of FA among US adults. To characterize FAQoL among a large, nationally representative adult sample, and its determinants, including sociodemographic characteristics, severity, comorbid conditions, allergic symptoms, number and type of allergens, and health care utilization. A survey was administered between October 2015 and September 2016 to a nationally representative sample of US households. Survey constructs included the Food Allergy Independent Measure (FAIM), which was developed to quantify adverse impacts of living with FA on patient quality of life. FAIM responses were analyzed from adults reporting current FA (N= 6207). Linear regression models examined associations with sociodemographic and FA characteristics. The overall estimated mean FAIM score was 2.87 (95% confidence interval: 2.83-2.90). FAIM scores (range= 1-7) in adjusted models were invariant by race/ethnicity, private/public insurance status, and census division. Significant differences (P < .05) by lower household income, lower age, and greater education emerged, resulting in higher FAIM scores indicating FAQoL impairment. Among major food allergens, wheat, soy, and milk allergies were each associated with the greatest increases in adjusted FAIM scores. Reporting a current epinephrine autoinjector (EAI) prescription, severe allergic reaction history, history of EAI use, FA-related emergency department visits, or more FAs were also associated with significantly higher FAIM scores. The population-level psychosocial burden of adults with FA is substantial, broadly distributed, and differs by demographic and allergic disease characteristics.