Use Of Autoinjectors Research Articles

Evaluation of Knowledge of Family Physicians on the Diagnosis and Treatment of Anaphylaxis and Adrenaline Auto-injector Use in Türkiye

Evaluation of Knowledge of Family Physicians on the Diagnosis and Treatment of Anaphylaxis and Adrenaline Auto-injector Use in Türkiye

Management of Severe Allergic-Like Contrast Media Reactions: Pitfalls and Strategies, From the AJR Special Series on Contrast Media.

Adverse reactions to contrast media, although uncommon, are often high-acuity events and potentially life-threatening. Nonetheless, these events are treatable, and radiologists may be called on to manage a contrast media reaction. However, because these events are infrequent, they are prone to management errors. This Special Series Review highlights common pitfalls and practical tips for the management of acute contrast media reactions in children and adults. Recognition of frequent management errors and implementation of the mitigation strategies presented can ameliorate risk and improve patient outcomes. These measures include proper training regarding reaction management and medication administration, the prompt use of intramuscular epinephrine autoinjectors whenever a severe allergic-like reaction is suspected, the use of visual aids for quick reference in the setting of a reaction, and the recognition of adverse events that are not allergic-like reactions, which commonly require only supportive care.

Evidence based use of epinephrine in anaphylaxis.

Epinephrine is the first line treatment for anaphylaxis, however, there are limited data to support this. This review examines data surrounding evidence for the use of epinephrine in anaphylaxis, data on prescription for and use of epinephrine autoinjectors, and data examining newer routes of delivery of epinephrine; with a focus on recent publications over the past few years. With recent epidemiologic studies of anaphylaxis and new forms of epinephrine being studied, new data on the effects of epinephrine are aiding in the understanding of epinephrine's effects and the shortcomings of epinephrine both in its effect and utility in the real world. Epinephrine is still considered the first line therapy for anaphylaxis, and we are starting to have a better understanding of its effects in both healthy patients and those with anaphylaxis.

Assessing the Knowledge of Anaphylaxis Management and Adrenaline Auto-Injector Administration among Parents of Children with Food Allergies: A Cross-Sectional Study

Background: Despite the importance of caregivers being trained in anaphylaxis management and the use of adrenaline auto-injectors (AAIs), studies have revealed inadequate caregiver knowledge. The caregiver anaphylaxis knowledge in an Irish population has not been previously assessed. This study aims to evaluate the anaphylaxis management knowledge and AAI administration proficiency among parents of children with food allergies. Methods: The parents of children with food allergies who were prescribed an AAI were invited to take part in a study involving online education. The participants completed an online questionnaire assessing anaphylaxis knowledge. They then took part in an online educational intervention where their AAI administration ability was assessed. Results: Out of a total score of 12, the mean anaphylaxis knowledge score was 9.76/12, SD 1.577, or 81.33%. Of the 152 participants, 26.7% (n = 40) performed all three critical AAI administration steps correctly. A household income under EUR 40,000 per annum reduced the likelihood of successful AAI administration (OR 0.33 95% CI 0.125–0.87, p = 0.025). Regarding the AAI devices, 46.4% claimed to have switched between devices at least once before. Conclusions: The parents demonstrated good knowledge of anaphylaxis management, but the prevalence of device switching underscores the importance of comprehensive AAI training. Future assessments should include evaluations of enhancements in knowledge, anxiety levels, and overall quality of life.

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.

The confidence and competence of primary school staff to administer an adrenaline auto-injector

School teachers are often inadequately prepared to use an adrenaline auto-injector (AAI), resulting in potentially dangerous treatment delays. The purpose of this study was to assess the observed competence, and self-reported confidence, of primary school teachers in the Republic of Ireland (RoI) to use an AAI. An evaluation of whether there was a link between confidence and competence was also assessed. Teachers from four primary schools in the RoI completed a questionnaire to assess their prior level of experience, training, and confidence levels with AAI administration. The four steps in administrating trainer AAI to a mannequin simulator were then assessed. A total of 61 teachers participated (out of a population of 80). The mean self-reported confidence was 1.82 out of 5 (SD = 0.96). There was no significant difference in confidence between trained and untrained participants (U = 240.5, NS). Participants who had received AAI administration training performed significantly more of the steps correctly (mean = 3.85, SD = 0.95) as compared to those who had received no training (mean = 2.97, SD = 1.10; U = 180.5, p = 0.008). There was no correlation between confidence in administrating AAI and the percentage of steps in the procedure performed correctly (rho = −0.17, NS). Conclusion: Improvements in readiness to administer AAIs can be achieved through the application of more effective approaches to teaching clinical skills, changes to school policies and practices, and consideration of the design of AAIs in order to make their operation safer and simpler. It is important that teachers have the confidence and competence to safely administer an AAI.What is Known:• Poor ability in adrenaline auto-injector use seen across population groups—healthcare professionals, patients, carers, and school staff• Training in the use of adrenaline auto-injectors has positive impact on competencyWhat is New:• Irish school teachers show poor levels of competency in adrenaline auto-injector use• No observed correlation between reported confidence and competency

Clinical characteristics and management of pediatric egg-induced anaphylaxis: A cross-sectional study

BackgroundEgg is the third most common food allergy in children; however, data on pediatric egg-induced anaphylaxis are sparse. ObjectiveTo describe the clinical characteristics, management, and outcomes of pediatric egg-induced anaphylaxis. MethodsChildren presenting with anaphylaxis were recruited from 13 emergency departments as part of the Cross-Canada Anaphylaxis Registry, from which data on anaphylaxis triggered by egg were extracted. Multivariate logistic regression was used to determine factors associated with prehospital epinephrine autoinjector (EAI) use and to compare anaphylaxis triggered by egg with other triggers of food-induced anaphylaxis (FIA). ResultsWe recruited 302 children with egg-induced anaphylaxis. The mean age was 2.6 years (SD = 3.6), and 55.3% were male. Only 39.4% had previously been diagnosed with an egg allergy. Prehospital EAI use was 32.1%, but this was not significantly lower than in other triggers of FIA (P = .26). Only 1.4% of patients required hospital admission. Relative to other triggers of FIA, patients with egg-induced anaphylaxis were significantly younger (P < .001) and exhibited more vomiting (P = .0053) and less throat tightness (P = .0015) and angioedema (P < .001). ConclusionTo the best of our knowledge, this is the largest published cohort of pediatric egg-induced anaphylaxis. In this cohort, prehospital EAI use was very low. In addition, we identified certain symptoms that distinguish egg-induced from other triggers of FIA. Taken together, high suspicion is crucial in identifying egg-induced anaphylaxis, given the younger patient demographic and frequent lack of FIA history.

Living with food allergies: the experiences of adult patients and caregivers.

Few studies have addressed how food allergy may impact differently on the daily lives of adults with food allergies and caregivers for food-allergic dependents. To explore similarities and differences in life experiences and unmet needs between individuals caring for a child with food allergy and adults with food allergy world-wide. Two multinational, virtual, interactive, moderated discussions of specific questions between respectively people with food allergies and caregivers for people with food allergies, with experienced clinicians participating. Sixteen individuals living with food allergies and nine caregivers took part in the two roundtables. Food avoidance and antihistamines were the most common treatments for food-allergic reactions in both groups. Caregivers reported greater burden of disease on affected individuals and families than did adult patients. Adult panelists considered autoinjectors easy to use but caregivers reported additional emotional stress thinking about autoinjector use. Caregivers described an ever-present fear of inattention and of overlooking a risk factor for a severe reaction, whereas adult panelists showed a determination not to let their food allergies interfere with living their lives. Both groups had safety-conscious attitudes to treatments, but adult patients emphasized convenience while caregivers prioritized reduced severity of reactions and eliminated fear. Both groups confirmed the need for improved, trusted sources of information, and for resources and training programs for any new therapies. The interactive exchange provided insights into differences between adult patients and caregivers, notably in fear and confidence in daily life, severity of disease impact, and unmet needs for treatments.

Characteristics of Pediatric Emergency Department Presentations of Anaphylaxis in Spain.

This study aimed to identify the triggers of pediatric anaphylaxis in Spain and to analyze the circumstances of the episode. Planned secondary analysis of a prospective observational multicenter study endorsed by the Spanish Society of Pediatric Emergencies including children aged younger than 18 years diagnosed with anaphylaxis in 7 Spanish pediatric emergency departments (EDs) between 2016 and 2018. We analyzed factors related to the anaphylaxis episode and its management. Four hundred fifty-three cases were registered, happening mainly at home (295 [65.1%]), school (65 [14.3%]), and street (61 [13.5%]). The median age was 5 years, 143 (31.6%) had previous episodes, and 165 (36.4%) had previously been prescribed an epinephrine autoinjector, used in 40 (24.2% of those prescribed). Two thirds were well-appearing when arriving to the pediatric ED. Food was the trigger in 396 (87.4%). In 349 with a single food involved, the most frequent were milk (108 [30.4%]), nuts (103 [29.0%]), hen's egg (40 [11.3%]), and fish (31 [8.7%]), with variations related to the age of the child. Food, especially milk and nuts, are responsible for most anaphylaxis diagnosed in Spanish pediatric EDs. Consideration should be given to improving health education due to the low use of epinephrine autoinjectors.

From Fear to Preparedness: A Systematic Review of Parents' Awareness and Use of Epinephrine Autoinjectors

This systematic review aims to synthesize existing literature on parents' knowledge and use of epinephrine autoinjectors (EAIs) and identify factors associated with correct use and barriers to education and training. A comprehensive search was conducted on PubMed and the Directory of Open Access Journals (DOAJ) using keywords and MeSH terms. Inclusion and exclusion criteria were established, and papers were screened for eligibility. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal tool. A total of 1008 papers were initially identified, with 214 remaining after applying filters. Following screening and quality assessment, seven observational studies were included in the review. The studies found that while most caregivers claimed to carry an EAI on their person and practiced its use at home after training, it was often not used during allergic reactions. The most common reason cited for not using EAI was uncertainty about whether the symptoms were severe enough to warrant EAI use. The lack of EAI use was significantly associated with lower caregiver confidence in using EAI. Those who received EAI during oral food challenges (OFC) and in the community had increased confidence in administering the EAI from pre-OFC to follow-up compared to those who did not receive EAI at all. Targeted interventions and educational strategies should be developed to improve parent knowledge and use of EAIs.

Development and validation of assessment tools for food allergy-related knowledge and management confidence.

Given the life-threatening nature of food allergy (FA), it is important to assess the level of knowledge among families with food-allergic patients and their ability to cope with anaphylaxis. This study constructed a FA knowledge questionnaire (FAKQ) and confidence in FA management skills (CIFAMS) questionnaire to assess understanding and attitudes toward FA management in food-allergic families. Items from literature review and expert panel showing ≥80% content validity index and semantic equivalence were selected for translation into Chinese. These questionnaires underwent feasibility pilot testing followed by cross-sectional validation to assess their psychometric properties of internal consistency, test-retest reliability, and construct validity with a FA quality-of-life questionnaire and discriminant validity. Exploratory factor analysis was performed to confirm their factor structure. A total of 155 subjects (104 patients and 51 parents) completed a 20-item FAKQ and 10-item CIFAMS. Both tools showed acceptable internal consistency in baseline and retest groups. FAKQ and CIFAMS correlated for all subjects (P=.002) and for adults (P= .002), and similarly between CIFAMS and parent-reported FA independent measure (P=.005). Total score of FAKQ was sensitive to within-group differences of patients hospitalized for FA (P< .001). FAKQ and CIFAMS items were factored into 4 and 2 domains, respectively. Subjects scored the lowest on FAKQ items about signs of allergic reaction and CIFAMS items on epinephrine autoinjector use. FAKQ and CIFAMS developed by our group are valid and reliable in assessing knowledge and confidence in FA management in patients and parents. These tools are crucial for formulating education programs and advocacy campaigns for FA.

Stability of Monoclonal Antibodies as Solid Formulation for Auto-Injectors: A Pilot Study.

Drug adherence is a significant medical issue, often responsible for sub-optimal outcomes during the treatment of chronic diseases such as rheumatoid or psoriatic arthritis. Monoclonal antibodies (which are exclusively given parenterally) have been proven to be an effective treatment in these cases. The use of auto-injectors is an effective strategy to improve drug adherence in parenteral treatments since these pen-like devices offer less discomfort and increased user-friendliness over conventional syringe-based delivery. This study aims to investigate the feasibility of including a monoclonal antibody as a solid formulation inside an auto-injector pen. Specifically, the objective was to evaluate the drug stability after a concentration (to reduce the amount of solvent and space needed) and freeze-drying procedure. A preliminary screening of excipients to improve stability was also performed. The nano-DSC results showed that mannitol improved the stability of the concentrated, freeze-dried antibody in comparison to its counterpart without it. However, a small instability of the CH2 domain was still found for mannitol samples, which will warrant further investigation. The present results serve as a stepping stone towards advancing future drug delivery systems that will ultimately improve the patient experience and associated drug adherence.

The Reliability of Auto-Injectors in Clinical Use: A Systematic Review.

Auto-injectors are medical devices designed for the self-administration of injections by patients and for easy administration by healthcare professionals in emergency situations. Although they vary in design and application, auto-injectors are typically built around a spring-loaded syringe. Despite their widespread use in a variety of clinical settings, there have been limited attempts to assess their reliability. This systematic review investigates the reliability of auto-injectors, identifies common causes of failure, and summarizes the overall rate of malfunction. A systematic review of research published on the PubMed and Cochrane Library databases was performed in July 2022. The relevant studies were assessed for their methodological quality and risk of bias prior to extracting key study outcomes on auto-injector reliability. Finally, a summary rate covering all eligible studies was calculated. The search identified a total of 110 articles, of which ten were found to be suitable for inclusion. The risk of bias was low, and the methodological quality was high across the ten studies. Out of a total of 2,964 injections administered from an auto-injector, there were 12 device malfunctions, giving a summary rate of 0.40% (±0.23) auto-injector failures. The causes of malfunction varied in nature, with the majority of cases (58.3%) not being specified or not identified. This review has demonstrated that auto-injectors are reliable devices. Although further research on the nature of malfunctions is needed, the low rate of malfunctions supports training programs for healthcare professionals and patients on the optimum use and maintenance of auto-injectors. It provides a rationale for their continued development.

Racial, Ethnic, and Socioeconomic Differences in Food Allergies in the US

Food allergies affect approximately 8% of children and 11% of adults in the US. Racial differences in food allergy outcomes have previously been explored among Black and White children, but little is known about the distribution of food allergies across other racial, ethnic, and socioeconomic subpopulations. To estimate the national distribution of food allergies across racial, ethnic, and socioeconomic groups in the US. In this cross-sectional survey study, conducted from October 9, 2015, to September 18, 2016, a population-based survey was administered online and via telephone. A US nationally representative sample was surveyed. Participants were recruited using both probability- and nonprobability-based survey panels. Statistical analysis was performed from September 1, 2022, through April 10, 2023. Demographic and food allergy-related participant characteristics. Stringent symptom criteria were developed to distinguish respondents with a "convincing" food allergy from those with similar symptom presentations (ie, food intolerance or oral allergy syndrome), with or without physician diagnosis. The prevalence of food allergies and their clinical outcomes, such as emergency department visits, epinephrine autoinjector use, and severe reactions, were measured across race (Asian, Black, White, and >1 race or other race), ethnicity (Hispanic and non-Hispanic), and household income. Complex survey-weighted proportions were used to estimate prevalence rates. The survey was administered to 51 819 households comprising 78 851 individuals (40 443 adults and parents of 38 408 children; 51.1% women [95% CI, 50.5%-51.6%]; mean [SD] age of adults, 46.8 [24.0] years; mean [SD] age of children, 8.7 [5.2] years): 3.7% Asian individuals, 12.0% Black individuals, 17.4% Hispanic individuals, 62.2% White individuals, and 4.7% individuals of more than 1 race or other race. Non-Hispanic White individuals across all ages had the lowest rate of self-reported or parent-reported food allergies (9.5% [95% CI, 9.2%-9.9%]) compared with Asian (10.5% [95% CI, 9.1%-12.0%]), Hispanic (10.6% [95% CI, 9.7%-11.5%]), and non-Hispanic Black (10.6% [95% CI, 9.8%-11.5%]) individuals. The prevalence of common food allergens varied by race and ethnicity. Non-Hispanic Black individuals were most likely to report allergies to multiple foods (50.6% [95% CI, 46.1%-55.1%]). Asian and non-Hispanic White individuals had the lowest rates of severe food allergy reactions (Asian individuals, 46.9% [95% CI, 39.8%-54.1%] and non-Hispanic White individuals, 47.8% [95% CI, 45.9%-49.7%]) compared with individuals of other races and ethnicities. The prevalence of self-reported or parent-reported food allergies was lowest within households earning more than $150 000 per year (8.3% [95% CI, 7.4%-9.2%]). This survey study of a US nationally representative sample suggests that the prevalence of food allergies was highest among Asian, Hispanic, and non-Hispanic Black individuals compared with non-Hispanic White individuals in the US. Further assessment of socioeconomic factors and corresponding environmental exposures may better explain the causes of food allergy and inform targeted management and interventions to reduce the burden of food allergies and disparities in outcomes.

Simulation Model of Required Pre-deployed Auto-injectors and Stockpiled Antidotes against Chemical Terrorism

Introduction:Chemical terrorist attacks using nerve gas require patients with immediate administration of antidote, or otherwise they will experience abnormal neurological activity, respiratory arrest, and death. When it occurs in large stadiums at mass gatherings such as the Olympics, under normal medical care systems, preventable deaths occur due to insufficient deployment of on-site auto-injectors and stockpiled antidotes in hospitals. In Japan, the government has stockpiled antidotes in confidential warehouses and deployed auto-injectors around possible terrorist sites. When a chemical attack occurs, a stockpile of antidotes go to hospitals, auto-injectors go to the site, and firefighters and police are allowed to administer auto-injectors to patients. However, few studies are conducted on pre-deployment of auto-injectors and antidotes in chemical terrorisms. Therefore, the number of pre-deployment was examined.Method:A single chemical attack with 750 patients was assumed. Response was divided into five steps: (1) transportation of stockpiles to hospitals, (2) transportation of auto-injectors to the site, (3) on-site use of auto-injectors, (4) transportation of patients to hospitals, and (5) patient care in hospitals. Computer estimation was used for the time required for transportation for (1), (2), and (4). Desktop exercises were conducted for on-site response time, outpatient response time, and the number of beds available at hospitals for (3) and (5). The values obtained from computer estimation and desktop exercises were imported into the simulation model to measure the number of paramedics, auto-injectors required to be deployed in advance, and the amount of stockpiles required to be delivered to hospitals.Results:A minimum of 80 auto-injectors and ten paramedics were required to be pre-positioned at the scene. A minimum of 100 ampules of antidote was required immediately at the nearest hospitals.Conclusion:The pre-deployment of auto-injectors and personnel are essential to reduce the number of deaths in the event of chemical terrorisms.

A Comparison of Instructions for Use Documents and Manufacturer Produced Administration Videos for Biological Products.

To compare Instructions for Use (IFU) and Manufacturer Produced Administration Videos (MPAV) for biological products to describe if they are highly similar or different. To identify differences between the two that may lead to medication errors and to point out possible solutions to optimize safety. We screened 139 biological products having both an IFU and a MPAV. Differences between the IFU and MPAV of each biological product were noted and categorized by importance and how likely it would cause harm to patients. Strategies were discussed based on differences observed. Of the products screened, 51 had an IFU and a MPAV available for evaluation. They were primarily made to support the use of auto-injectors (n = 25) and pre-filled syringes (n = 19). Of this group, we found that 11 had no differences between the IFU and MPAV, while the other 40 had at least one or more identifiable differences. Differences were stratified into the following sub-categories from most to least prevalent: word choice differences, supplementary information, missing information, and unaligned directions. We looked at the distribution of differences per biological product and found an average of two differences per MPAV (IQR 1-3). We suggest that when sponsors create or update MPAVs, to focus on aligning critical content between the respective IFU and MPAV. We believe that it is possible for MPAVs to potentially reduce medication errors as a non-text-based media form and that care should be taken to avoid substantial differences in critical content between the IFU and MPAV.

The adherence of parents regarding epinephrine auto-injector use in anaphylaxis management: a real-life study

Purpose: The purpose of this study was to identify unmet needs in the management of anaphylaxis by assessing the practical skills of the parent(s) regarding the use of epinephrine auto-injectors (EAIs) and determining the factors influencing them.&#x0D; Materials and Methods: The study included 114 primary caregivers of children prescribed an EAI with an anaphylaxis risk. A structured mini-interview with a practice test using a trainer device was performed.&#x0D; Results: Epinephrine was described as a life-saving and first-line treatment for anaphylaxis by 93 parents (81.6%). However, only 53 parents (46.5%) stated that they carry an EIA device with them regularly in their daily lives. 38 children (33.3%) had relapsing episodes, but among those experiencing anaphylaxis, only 6 parents (20%) used EAI despite carrying. According to respondents, the main factor avoiding AEI's regular carriage was a lack of belief in necessity (18, 29.5%). Among participants, only 13 (11.4%) of the parents were able to administer EAI correctly in all 5 steps. An inverse relationship between the ability to use the device and the time elapsed since the last visit s was found.&#x0D; Conclusion: Low adherence levels among parents highlighted the urgent need to improve this situation. Interventions including regular EAI training and psychological support should be provided among parents, but may not guarantee to maintain acquired adherence to EAIs in real life.

Preparedness and Knowledge Level of Family Physicians Regarding Anaphylaxis Diagnosis and Management

Objective: Anaphylaxis is under-recognized and undertreated by physicians, indicating critical knowledge gaps. This study aimed to assess the knowledge levels of anaphylaxis among family physicians (FPs) as they are the primary first-line healthcare providers and identify the factors influencing their knowledge levels. Materials and Methods: A cross-sectional study using an internet-based Google Forms questionnaire was conducted among voluntary FPs in Sivas, Turkey. Demographic features, including age, years in practice, career position, and knowledge related to the diagnosis and management of anaphylaxis in children were assessed. Results: A total of 149 FPs participated in the survey (34 [24.3%] general practitioners [GPs], 20 [14.3%] contracted family physicians [CFPs], 74 [52.9%] residents in training [RITs], and 12 [8.6%] specialists). The number of participants who correctly answered all questions regarding diagnosis, acute treatment, and epinephrine auto-injector use was 11 (7.9%), 52 (37.4%), and 27 (19.3%), respectively. In diagnosing anaphylaxis, 100 (72.5%) participants were unaware that anaphylaxis can occur without skin manifestations, and only 48 (34.8%) identified gastrointestinal symptoms as a possible anaphylaxis presentation. RITs (11, 14.9%) and specialists (2, 16.7%) had better performance on the questionnaire, with higher proportions of participants who answered all questions correctly, compared to GPs (2, 5.9%) and CFPs (1, 5.0%). Attendance at an educational activity in the last year was the only independent factor associated with answering all questionnaire items correctly. Conclusion: There is a need to improve anaphylaxis recognition and management among all FPs regardless of their career position and work experience, underlining the importance of regular and updated educational interventions.

Digitalizing Anaphylaxis Emergency Action Plans: What Is Currently Available To Patients?

Timely use of epinephrine is the well-recognized treatment of choice in anaphylaxis. Paper-based anaphylaxis action plans are commonly used to guide patients and caregivers on when and how to use epinephrine. However, epinephrine administration by lay people remains low. Most common reasons for this have been described as fear of making a mistake, incorrect assessment of symptoms, and poor knowledge of the correct epinephrine autoinjector use. Data is lacking on the role of mobile health (mHealth) apps in digitalizing anaphylaxis emergency action plans and bridging the gaps in care.

Evaluating the Food Allergy Passport: A Novel Food Allergy Clinical Support Tool

The prevalence of pediatric food allergy (FA) has increased in the past 2 decades. The previous literature suggests that FA presents burdens, both economically and psychosocially, to children and their caregivers, especially families in lower-income strata. Using data from a previously published needs assessment, the Food Allergy Management in Low-Income Youth study, the FA Passport and Workbook tools were developed to address identified needs. This study evaluated the utility of the FA Passport in helping families insured by Medicaid to manage FA better and improve quality of life. Families insured through Illinois Medicaid were recruited from two Chicago-based allergy clinics. Caregivers of children with FA completed a pretest evaluating knowledge, attitudes, beliefs, and practices regarding FA management. A clinician guided caregivers through the FA Passport. The caregivers then completed a posttest immediately afterward and again 3 months later. Changes were evaluated from baseline responses and direct feedback was elicited about the tool. The FA Passport successfully improved caregiver-reported confidence with epinephrine autoinjector use (from 69% to 93%), caregiver anaphylaxis recognition (from 66% to 73%), and reported quality of life, and it nearly doubled caregiver comfort regarding leaving the child in the care of others (from 40% to 75.7%). Caregivers rated the FA Passport tool as extremely helpful overall (9.4 out of 10). The FA Passport is a novel FA clinical support tool that addresses barriers to proper FA management described in previous studies. It proved effective at improving caregiver comfort with regarding leaving the food-allergic children with other caregivers, increasing FA knowledge, and improving the quality of life in families affected by FA.