Use Of Epinephrine Autoinjectors Research Articles

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 approachesto 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 competency What 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.

Evaluation of the origin and educational quality of youtube videos on adrenaline auto-ınjectors.

Background. Guidelines highlight the pivotal role of adrenaline auto-injector (AAI) training. However, the standards of visual training platforms has not been determined. Our aim was to evaluate the reliability and quality of the AAI related videos on YouTube. Methods. After a search on YouTube about AAI, all videos were categorized into groups based on their origin and the aim of the content. The quality, reliability, understandibility, and actionability of the videos were evaluated using the Global Quality Scale (GQS), Patient Education Materials Assessment Tool Audovisiual (PEMAT-A/V), Quality Criteria for Consumer Health Information (DISCERN), and a modified DISCERN. In each video, the application steps of AAI were evaluated according to a scale of correct usage. Results. 107 YouTube videos in English were included. No significant difference in terms of views, likes, duration and uploading time was observed between the health and non-health groups whereas the GQS (p=0.001), DISCERN (total: p=0.02, and overall: p=0.094), modified DISCERN (p=0.001) scores were higher in the health group. It was found that scores tended to be higher in educational videos. AAI use was mentioned in 85% videos. The median number of mentioned steps was 6. Conclusions. YouTube is an effective platform for visual learning for the use of AAIs. Although the visibility of the videos is equal independent of the origin, the ones recorded by medical professionals seem to provide the most qualified and reliable information.

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

Adverse reactions to contrast media are often high-acuity events that are uncommon potentially life-threatening. Nonetheless, these events are treatable, and radiologists may be called upon to manage a contrast media reaction. However, because these events are infrequent, they are prone to management errors. This article 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 on reaction management and medication administration, the prompt use of IM 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.

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.

Epinephrine autoinjector prescribing following anaphylaxis presentation to the emergency department.

Background: Guidelines recommend patients with anaphylaxis are prescribed epinephrine autoinjectors (EAI), carry the EAI with them, and are referred to an allergist. There also are barriers to EAI administration, such as acquiring the medication, having it available, recognizing when to use it, and administering it appropriately. Objective: The objective was to describe how often patients with anaphylaxis discharged from the emergency department (ED) receive an EAI prescription and allergist referral; also, to assess the frequency of EAI pick-up by the patient from the outpatient pharmacy, out-of-pocket cost, change in EAI device during dispensing, and if patient training on EAI use and allergist follow-up occurred. Patient-specific factors associated with the occurrence of these variables were investigated. Methods: This was a retrospective, observational study of adult and pediatric ED patients who presented with anaphylaxis between July and December 2020. Data were collected from medical records and telephone calls to outpatient pharmacies and included patient demographics; ED treatment; EAI prescribing, EAI pick-up from the outpatient pharmacy, and cost; device changes; EAI training; and allergist referral and follow-up. Data are presented descriptively, and bivariate analyses were used for comparisons between patient-specific factors and incidence of EAI prescribing, patient pick-up, and allergist referral. Results: A total of 102 patients were included; mean age ± standard deviation 34 ± 7 years, 52% were < 18 years of age; and 54% had a history of allergy and/or anaphylaxis. EAI prescribing occurred in 79% of the patients. Of these, 71% picked up the EAI from the outpatient pharmacy, the median cost to the patient was $5 (range, $0-$379), 18% had an EAI device change at dispensing, and 23% received EAI training. Allergist referral occurred in 22%, and 28% followed up with an allergist within 60 days. Presenting symptoms of mucosal edema and respiratory stridor were associated with the occurrence of EAI prescribing. Presenting symptoms of respiratory wheezing, hoarseness, throat itching, skin flushing and allergist referral from the ED were associated with the occurrence of EAI pick-up from the outpatient pharmacy. Conclusion: Overall, 79% of ED patients with anaphylaxis had an EAI prescribed and 22% had an allergist referral; 71% picked up the EAI from the outpatient pharmacy, EAI dispensing changes occurred, and training was infrequent. Collaboration between emergency medicine clinicians, allergists, and pharmacists is needed to streamline treatment and follow-up.

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.

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.

Food Allergy Management Competence in Greek Schools

Schoolchildren are likely to consume meals and snacks at school, with a possibility of allergic food reactions and anaphylaxis in the school environment. The school personnel should be informed of the presence of schoolchildren with food allergy (FA) and need to be trained in the management of allergic reactions, as to prepare them to intervene appropriately when necessary. Limited knowledge of FA and its management is documented globally among school staff and there is no uniform protocol in schools. In this observational cross-sectional study, teachers at state schools throughout Greece completed an online anonymous questionnaire on their awareness of FA reactions and the plans for the management of medical emergencies in their schools of employment. Among the 289 teachers who responded the online invitation, 203 (70.24%) were female and 157 (54%) were aged under 40 years. Females expressed a higher level of concern about the presence of school personnel trained to manage FA symptoms (p = 0.001), written instructions, and the availability of adrenaline (epinephrine) at school (p < 0.001). A younger age was associated with a higher level of both interest and knowledge on FA management in schools. School directors were more certain about the availability of a special record of children with FA at school (p = 0.01), the availability of adrenaline (p = 0.006), and written guidelines on the management of serious health incidents at school (p = 0.04). Written guidelines instructing children to avoid sharing cutlery, glasses, home-prepared meals, and snacks bought from the school canteen were more common in schools in urban areas (p = 0.015). Only 20% of respondents could confirm with certainty that adrenaline autoinjectors (AAIs) were available at their schools, for the purpose of administering to children in the case of a severe FA reaction. Approximately 3/4 of the participating teachers stated that completion of this questionnaire raised their awareness of the risk of FA reactions in children at school. This study, the first in Greece to explore the knowledge of teachers about FA in schoolchildren, revealed the following absences in many schools: a process for identifying children with FA, a written emergency treatment plan, and immediate access to emergency AAI. School FA guidelines are necessary in Greece, and training, which includes the use of AAIs, is required to prepare teachers to manage FA reactions in children at school.

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.

Management Of Anaphylaxıs In Pedıatrıc Populatıon.

Although an increase in the incidence of childhood anaphylaxis has been reported, it remains underdiagnosed. Foods are the most common triggers for anaphylaxis, particularly cow's milk, hen's egg, and nuts. Other common causes of anaphylaxis in children and adolescents include venom and drugs. The skin is the most commonly affected organ, but approximately 10% of patients with anaphylaxis may present without skin symptoms, which can lead to misdiagnosis. Recognition of anaphylaxis is a great challenge in children, possibly due to a lack of vigilance among patients, caregivers, and healthcare professionals, but also in part due to discrepancies in the clinical definition of anaphylaxis. In addition, anaphylaxis in infants often poses a distinct challenge because the wide spectrum of clinical manifestations and the inability of infants to describe their symptoms may hinder prompt diagnosis and treatment. Given the rapid onset of anaphylaxis and its unpredictable severity, rapid assessment and appropriate treatment are critical. Although the morbidity and mortality associated with anaphylaxis are potentially preventable with the timely administration of life-saving epinephrine, anaphylaxis is still undertreated worldwide. Long-term management of pediatric anaphylaxis is a patient-centered, multidimensional approach that focuses on the recognition of anaphylaxis, the use of epinephrine auto-injectors, and prevention of recurrences. Therefore, close communication and collaboration between the child, caregivers, healthcare professionals, and schools is the cornerstone of long-term care. This paper is designed to provide a comprehensive overview of current perspectives and concepts related to anaphylaxis in the pediatric population in light of recent guidelines and literature.

Evaluation of the triggers and the treatment models of anaphylaxis in pediatric patients.

Anaphylaxis is an acute, life-threatening systemic hypersensitivity reaction. We aimed to evaluate the demographic and clinical characteristics of patients presenting with anaphylaxis, as well as triggers and risk factors, and to determine the rate of adrenaline auto-injector (AAI) usage. The study was planned in the pediatric allergy outpatient clinic over a 1-year period. The data of children diagnosed with anaphylaxis were evaluated retrospectively; demographic characteristics, causes of anaphylaxis, and treatment modalities were recorded in the created study form. Eighty children (29 females) with a median age of 6.5 years (range: 1 month-17 years) were evaluated. The most common triggers were foods under 2 years of age (73%), and drugs (70%) above 2 years of age. Nearly half of the anaphylaxis episodes (n=41, 51.3%) occurred at home. Cutaneous and respiratory symptoms were the most commonly reported complaints (98.8%). The median age of the patients at the first attack with severe anaphylaxis (n=29, 36.3%) was significantly higher than the rest (p:0.007). The age at onset of the reaction (p:0.006) and occurrence of the reaction in hospital conditions (p<0.001) were determined to be significant risk factors for severe anaphylaxis. Most of them received antihistamines (95.7%) and corticosteroids (91.3%), while 78.3% received adrenaline. Only 9.5% of patients with recurrent episodes of anaphylaxis used AAIs. Foods in infants and drugs in older children were the leading causative allergens of anaphylaxis. The most common clinical manifestations were respiratory and cutaneous symptoms. The older age at onset of the reaction and the occurrence of the reaction in hospital conditions were determined to be significant risk factors for severe anaphylaxis. It was determined that the frequency of AAI use was low among patients and their families.

Anaphylaxis: Long-term management and resources.

Background: Anaphylaxis is an acute life-threatening event that requires emergent diagnosis and treatment. However, focus on prevention of anaphylaxis is essential in reducing anaphylaxis recurrences and associated mortality. Objective: This literature review was aimed to be a comprehensive resource for practicing allergists in managing anaphylaxis in the long term. We discussed the role of the allergist in the long-term outpatient management of anaphylaxis through identifying risk factors, allergen avoidance, prevention of recurrences, and patient education. Methods: A medical literature search that focused on several areas of long-term management of anaphylaxis was conducted. Results: Patients evaluated by an allergist are more likely to have their anaphylaxis trigger identified, to have their underlying mast cell disorder diagnosed, and to receive desensitization or allergen immunotherapy. Allergists can prevent fatal anaphylaxis by preventing and treating anaphylaxis in patients with ischemic heart disease and by optimally treating patients with comorbid asthma. Allergists can offer specific prevention strategies for allergenic trigger and cofactor avoidance. Education should be focused on patients with a higher risk for recurrence of anaphylaxis, such as those patients with a history of severe symptoms or anaphylaxis, with a peanut and/or tree nut trigger, or with a history of asthma, or female gender. Patient counseling involves providing individualized action plans at each visit and discussing proper use, storage, and safety of epinephrine autoinjectors. Multiple doses of epinephrine need to be prescribed to those who are at risk for severe food-induced, venom immunotherapy-related, or venom-induced anaphylaxis. Wording on medical identification products should be reviewed by the allergist. Anaphylaxis resources for health-care providers are summarized in the article. Conclusion: Ongoing education, providing personalized anaphylaxis action plans, reducing risk factors, and avoiding triggers are key to anaphylaxis prevention and long-term management.

EPINEPHRINE AUTOINJECTOR UTILIZATION AND ACCESS IN A NATIONALLY REPRESENTATIVE FOOD-ALLERGIC ADULT SAMPLE

<h3>Introduction</h3> Food allergy (FA) affects over 32 million people in the United States. Timely epinephrine access is vital to treat FA-induced anaphylaxis. Research has demonstrated that only about half of FA patients have immediate access to epinephrine autoinjectors (EAIs). With the rising prevalence of adult-onset FA, more research is needed to understand epinephrine utilization in FA adults. <h3>Methods</h3> An online, IRB-exempt survey was developed by a multidisciplinary team of patient advocacy groups, physicians, caregivers, and survey methodologists to capture FA community needs. A nationally representative sample of adult FA patients was recruited by Evaluative Criteria Inc. in May 2022. <h3>Results</h3> 1,006 FA adults completed the survey. Among the sample, 61% self-identified as Caucasian, 16% as Black, 15% as Hispanic, and 7% as Asian, Native American, or Other. Only 52% of adults reported having ever been prescribed an EAI. The top reported reasons for access gaps were "my doctor did not indicate it was really needed," and "I don't believe I need it." A history of EAI prescriptions was highest among those with private health insurance (59% through employer, 68% self-purchased) and lowest among those on Medicare (48%) and Medicaid (51%). Only 33% of adults reported having an unexpired EAI, and fewer (25%) always had access to EAIs. <b>Thirty-six percent</b> of adults believe that EAIs can cause life-threatening side effects. On average adults reported paying $476 (SD = $971) out-of-pocket in the past year for EAIs. <h3>Conclusions</h3> Expanding EAI use and access among FA adults should be a priority for physicians, patient advocacy organizations, and beyond.

Knowledge Levels of Pediatric Assistants on Anaphylaxis Management and Adrenaline Autoinjector Application Skills: Pretraining and Posttraining Evaluation

Aim: The study aimed to evaluate the knowledge levels of pediatric residents about the treatment of anaphylaxis and the correct application skill of adrenaline auto-injector (AAI) and to determine the contribution of short-term training to this level.&#x0D; Material and Method: A questionnaire form was distributed to evaluate the basic information about the anaphylaxis treatment. And, all participants were asked to demonstrate the use of AAI using demo devices and mannequins. This assessment was considered a ‘Pre-Test’. At the end of the training, the steps of AAI use were re-evaluated. The data coming from this re-evaluation were recorded as ‘Post-Test’.&#x0D; Results: A total of 110 pediatric residents were included in our study. Most of the participants (94.6%) correctly knew that the first drug to be administered in the treatment of anaphylaxis was adrenaline. And also, 99.4% of the participants knew that adrenaline treatment should be administered intramuscularly. When asked where to apply adrenaline, 94.6 of the participants gave the correct answer. When the AAI application technique is evaluated with the pretest; It was observed that frequent mistakes were made in some steps. With the Post-Test applied after the training almost all the participants were able to complete the steps flawlessly&#x0D; Conclusion: It is important to increase the knowledge level, identify faulty steps, if any, and repeat the training of physicians who are obliged to supervise the AAI application technique of patients during outpatient follow-ups.

Impact of Reaction Setting on the Management, Severity, and Outcome of Pediatric Food-Induced Anaphylaxis: A Cross-Sectional Study

Prompt epinephrine autoinjector (EAI) use is the primary treatment for anaphylaxis. However, limited Canadian data exist on the impact of reaction location on EAI use for food-induced anaphylaxis (FIA). We sought to investigate the setting, management, and severity of pediatric FIA. We recruited children presenting with FIA from 11 Canadian emergency departments. Patient demographics and the setting, management, and symptoms of FIA were collected by standardized questionnaire. Factors associated with prehospital EAI use and reaction severity were determined by logistic regression. We recruited 3,604 children; 60.2% were male and the median age was 5.0 years (interquartile range 1.8-11.0). Among cases with a known location of FIA (85.0%), home was the most common setting (68.1%), followed by school/daycare (12.8%), other locations (11.4%; eg, park, car), and restaurants (7.4%). In the prehospital setting, EAI was administered in 36.7% of reactions at home, 66.7% in school/daycare, 40.2% in other locations, and 44.5% in restaurants. Relative to reactions occurring at school/daycare, prehospital EAI use was less likely at home (adjusted odds ratio [aOR] 0.80; 95% CI 0.76-0.84), in restaurants (aOR 0.81; 95% CI 0.75-0.87), and in other settings (aOR 0.77; 95% CI 0.73-0.83), when data were adjusted for reaction severity, sex, age, comorbidities, and province. The FIA setting was not associated with reaction severity or hospitalization. Prehospital EAI use was higher at school/daycare than in other settings, potentially owing to the presence of policies and training on FIA. Setting-specific interventions including educational programs and policies/laws mandating training and stocking an EAI may improve anaphylaxis recognition and treatment.