Management Of Anaphylaxis In Children Research Articles

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.

Mass food challenges in a vacant COVID-19 step-down facility: reflections on the management of anaphylaxi

A popular western misconception dating back to at least the time of President John F Kennedy is that one of the Chinese characters in the word “crisis” means opportunity. The manuscript “Management of anaphylaxis in children undergoing oral food challenges in an adapted COVID-19 field hospital”

Prevention and long-term management of anaphylaxis in children

Anaphylaxis is increasingly in children. Foods are the most common triggers. Anaphylaxis is currently undernotified, underdiagnosed, and undertreated in China. Recurrence of anaphylaxis has been recorded in one-third of cases, thus it is essential to prevent recurrence in long-term personalized management of anaphylaxis. Here it reviews the avoidance of triggers and cofactors/risk factors,long-term management of anaphylaxis. This article aims to increase awareness of anaphylaxis in children in order to improve management and prevention of recurrences.

Increased Use of Adrenaline in the Management of Childhood Anaphylaxis Over the Last Decade

To determine if the management of anaphylaxis in children had improved over a 10-year period after the introduction of intensified training programs and new anaphylaxis guidelines, relating in particular to the use of adrenaline (epinephrine).The population included 136 children <17 years of age who presented to the main tertiary pediatric emergency department in Perth, Australia, with anaphylaxis from January 1, 2003, to December 31, 2004, and 177 children from January 1, 2012, to December 31, 2012, after intensified training programs and new anaphylaxis guidelines were developed.The investigators used a retrospective chart review, using the criteria from the 2006 Second National Institute of Allergy and Infectious Diseases Food Allergy and Anaphylaxis Network symposium. All cases coded as anaphylaxis were independently reviewed to verify the diagnosis. The intensified training program was mandatory for all trainees rotating through the pediatric emergency department and was taught by a pediatric allergist and pediatric emergency physician.There were significant increases in the appropriate treatment of anaphylaxis with adrenaline before and after arrival in the pediatric emergency department, reduced use of adjunctive medications, a greater proportion of children discharged with an adrenaline autoinjector, and a greater proportion of children referred to allergy services between the 2 time periods.An intensified training program for medical staff and improved cooperation between pediatric emergency specialists and allergists has improved the management of pediatric anaphylaxis over this 10-year period.Use of epinephrine and compliance with anaphylaxis guidelines have been dismal in the United States and Europe, with significant underuse of epinephrine, low rates of discharge prescriptions for epinephrine autoinjectors, and low rates of referral to allergists. In this article, investigators demonstrated that an intense training program for both allergists and pediatric emergency department physicians can improve the compliance with anaphylaxis guidelines and should be of particular interest to training program directors of pediatric programs. Even with this intensified training program, however, mismanagement still occurred in 24.5% of patients.

Intervention in anaphylaxis: the experience of one paediatric centre based on NORA reports.

Intramuscular adrenaline administration is the primary intervention in anaphylaxis. To analyse the data on intervention in children admitted due to anaphylaxis to the tertiary paediatric centre and compare them to the data from the Network for Online-Registration of Anaphylaxis. A validated structured on-line questionnaire was used to collect data concerning the first and second-line intervention in anaphylaxis. The study was conducted in cooperation with the European Anaphylaxis Registry. The study group comprised 114 children (76 boys, 66.87%) aged 5 months-17 years with the predominance of moderate-to-severe anaphylaxis (grade III in Ring and Messmer's, and grade IV in Mueller's scale). In 103 (90.4%) children the first line of medical intervention was provided by medical staff. In the first-line intervention 39 (34.8%) children were given adrenaline. Five (4.4%) children were given the second dose of adrenaline and were admitted to the intensive care unit. In the second-line intervention adrenaline was given to 12 (15.6%) children. In one third it was at least the second reaction to the same trigger. Children treated with adrenaline were older (9.3 ±4.8 years), in comparison to those not treated (7.3 ±4.6 years, p = 0.034). Directly after the episode of anaphylaxis the children got the prescription for the adrenaline autoinjector in 35.1%, emergency training in 7.9%, and counselling on the avoidance of the anaphylaxis trigger in 30.7%. Grade III R&M reaction increased 3-fold the odds of AAI prescription (95% CI: 1.08-8.15). There is a strong need to continue education on proper management of anaphylaxis in children.

Management of anaphylaxis in children: a survey of parents and school personnel in Qatar

BackgroundAllergies are a growing health concern with a significant impact on quality of life and healthcare costs. It is critical to develop an appropriate care plan to deal with children’s...

Anaphylaxis in the community: a questionnaire survey of members of the UK Anaphylaxis Campaign.

ObjectivesTo examine the circumstances, features and management of anaphylaxis in children and adults.DesignSelf-completed questionnaire.ParticipantsThe age of participants ranged from 0 to 72 years.SettingWe analysed data from self-completed questionnaires collected over a 12-year period, i.e. 2001–2013, available to people by phone and, since 2012, for online completion through the Anaphylaxis Campaign.Main outcome measureWe analysed data from self-completed questionnaires collected over a 12- year period, i.e. 2001-2013, available to people by phone and, since 2012, for online completion through the Anaphylaxis CampaignResultsIn total, 356 questionnaires were submitted, of which 54 did not meet the criteria for anaphylaxis. The remaining 302 anaphylactic reactions originated from 243 individuals; 193 (64%) of these reactions were in children. Approximately half of all reactions occurred at home (n = 148; 49%); 61% (n = 193) of reactions occurred in those reporting a history of asthma, and many (n = 76; 41%) of these individuals had asthma that they classified as being severe. In 57% (n = 173) cases, the respondent reacted to a known allergen. Self-injectable adrenaline (epinephrine) was available in 79% of the cases, and it was only used in 38% of episodes. The usage of self-injected adrenaline was lower in children (30%) than in adults (54%), even though 82% of children had adrenaline available at the time of the reaction compared to 74% of adults.ConclusionsThese data suggest that the majority of anaphylaxis reactions are triggered by exposure to known food allergens and that approximately half of these reactions occur at home. Access to self-injectable adrenaline was sub-optimal and when available it was only used in a minority of cases. Avoiding triggers, access to self-injectable adrenaline and its prompt use in the context of reactions need to be reinforced.

G444(P) An audit of the management of anaphylaxis in children in a district general hospital

Aims To assess how management of anaphylaxis in children complies with local and national guidance. Methods Retrospective review of 20 cases of paediatric anaphylaxis, diagnosis agreed by consensus between two physicians. Results Features of the acute reaction were well documented (Figure 1). However only 75% of children had their blood pressure recorded. The circumstances around the reaction were also well documented and likely triggers identified in all cases. 95% implicated a food allergen; 63% of these were nuts or nut–containing products. 85% of children received IM adrenaline, mostly pre-hospital and often by parents (Figure 2). Steroids formed part of the acute management in 95% of cases, and antihistamines in 100%. 75% of children were discharged with a course of steroids and antihistamines. The clinical timescale was less well recorded; 30% did not have the time of the onset of the reaction documented, and 27% of children who received pre-hospital adrenaline did not have the time documented. All children were observed for 6 h minimum. Documentation of counselling was poor with only 35% receiving allergen avoidance advice and 20% warned about the possibility of biphasic reaction. An adrenaline auto–injector (AAI) was offered to 70%. 57% of those received a documented explanation and demonstration of its use. 95% were discharged with a GP letter and 80% had a specialist allergy referral. Discussion and conclusion The results revealed opportunities for improvement. There is a high standard of history-taking and examination, though an estimated timescale is often not obtained and blood pressure is not consistently measured. Documentation of counselling needs improvement. The pharmacological management of anaphylaxis is excellent in the acute setting but substandard at discharge with children leaving hospital without antihistamines, oral steroids and most importantly AAIs. The proportion receiving prompt pre-hospital treatment with their own AAIs highlights their usefulness and the need to ensure they are prescribed to children at risk. Overall there is good adherence to guidance but simple measures such as a proforma, patient leaflet and personalised allergy action plan available for printing with the local guideline could further optimise patient care. A re-audit to assess the impact of these interventions is planned for 2015.

Knowledge and mindset on anaphylaxis management in children and teenagers among caregivers in Slovenia

Results 138 participants were included. 75% of participants recognised correctly signs of anaphylaxis before and 74% after the course. Regarding the correct position during anaphylaxis there were 77% correct answers before the course and 99% after. The rate of correct answers about adrenaline being the most important drug during the anaphylaxis increased from 72% before the course to 100% afterwards. Regarding the correct order of management during the anaphylaxis there were 57% correct answers in the pre-course questionnaire and 94% in the post-course questionnaire. 33% of participants answered correctly the question about the correct application of adrenaline auto-injector Epipen before the course and 93 % after the course. 70% of participants would give adrenaline by auto-injector to the child with anaphylaxis before the course and 96% after the course. 29% of all participants were worried about the side effects of adrenaline, 34% of all about the legal consequences and 20% about the injury of a child with a needle. 43% of the participants believed public awareness campaign would contribute to better management of anaphylaxis in children, 34% of all thought the regulation of legislation is needed. Only 13% felt competent to help the child with anaphylaxis before the course but after the course that percentage raised to 71%.

Anaphylaxis in Children: Current Understanding and Key Issues in Diagnosis and Treatment

Anaphylaxis is a severe allergic reaction that is rapid in onset and may cause death. Since it is unpredictable and potentially fatal, prompt recognition and treatment are vital to maximize a positive outcome. The occurrence of anaphylaxis is increasing across all ages in the United States, with increased risk of worse outcome in teenagers/young adults and in those with comorbid conditions such as asthma. Gaps in the assessment of patient-specific risk factors, identification and prevention of triggers, recognition of signs/symptoms, and pharmacologic treatment of anaphylaxis have been identified at the physician and caregiver/patient level. A PubMed literature search (January 2000–December 2011) was conducted to identify publications on childhood anaphylaxis using the following terms: food allergy, food allergens, food hypersensitivity, epinephrine, epinephrine auto-injectors, anaphylactic triggers, and anaphylaxis. This review will critically appraise these key issues and highlight strategies that might result in improved management of anaphylaxis in children.

Triggers, clinical features and management of anaphylaxis in children

This article describes the clinical features of anaphylaxis in children and young people. The acute management of anaphylaxis in hospital and community is described and various prevention strategies are discussed.

Recognition and management of anaphylaxis in children

AbstractOur series Prescribing in children gives practical advice for the management of childhood problems in general practice. Here, the authors discuss the emergency and long‐term management of anaphylaxis. Copyright © 2010 Wiley Interface Ltd

Management of Anaphylaxis in Children

Anaphylaxis is a severe, life-threatening immunoglobulin E (IgE)-mediated hypersensitivity reaction. The key to successful management of anaphylaxis involves rapid diagnosis, assessment, and early initiation of therapy. Epinephrine is the undisputed initial therapy for anaphylaxis, and its administration should never be delayed. In most cases, additional interventions such as oxygen therapy, fluid resuscitation, beta-agonists, antihistamines, and corticosteroids should be strongly considered. Although hospital course must be individualized to meet each patient's needs, a minimum of 4 to 6 hours of observation period after complete symptom resolution may be reasonable to monitor for recurrence of symptoms and biphasic reaction. Before discharge, every patient should receive patient education about anaphylaxis, a prescription for self-injectable epinephrine, and instructions for follow-up care.

Management of Anaphylaxis in Children

Pediatric Emergency Care: December 2008 - Volume 24 - Issue 12 - p 867-869 doi: 10.1097/01.pec.0000311640.56489.20

Diagnosis and Emergent Management of Anaphylaxis in Children

Anaphylactic and anaphylactoid reactions are serious, potentially life-threatening reactions with well-described clinical manifestations. Although the pathophysiology of these reactions varies with the offending agent and route of exposure, the treatment remains the same. Attention to airway, breathing, and circulation and the prompt administration of epinephrine remain the mainstays of therapy. Once an at-risk individual is identified, the proper instruction on the avoidance of the offending agent, the use of the EpiPen, and referral to a specialist in the treatment of allergic reactions may be instrumental in the future health and safety of that patient.

The prevention and management of anaphylaxis in children

The severity of allergic reactions covers a spectrum, from mild (e.g. facial urticaria) to severe (severe dyspnoea and/or hypotension). Anaphylaxis represents an extreme end of this spectrum and has unpredictable and life-threatening consequences. In the adult population it is most often caused by drugs, food and hymenoptera venom, but in young children food and drugs are usually responsible. The incidence has increased over recent years, a trend seen in all allergic disease. Treatment of acute anaphylaxis is described. Prevention of further episodes is vital and is most effectively achieved by early referral to a specialist allergy clinic. The cause of anaphylaxis may then be determined, detailed advice given on allergen avoidance and treatment of further reactions, with training of carer/school in allergen avoidance and self-administration of emergency medication. This approach has been shown to reduce the number and severity of subsequent allergic reactions and provides a model of good practice applicable to all causes of anaphylaxis.