Anaphylaxis in adolescents

Nwaru, Bright I.; Sheikh, Aziz

doi:10.1097/aci.0000000000000176

Cited by 9 publications

(2 citation statements)

References 27 publications

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“…Despite a diagnosed allergy and prescribed EAI, the World Allergy Organization noted the compliance rates of patients and caregivers carrying EAIs and remaining competent in their use decreases significantly over time (Simons et al, 2013). This is a particular problem with adolescents where the risk of anaphylaxis morbidity and fatality is disproportionately high (Greenhawt et al, 2018;Nwaru & Sheikh, 2015). Spina, McIntyre, and Pulcini (2012) found that only half of adolescents prescribed an EAI carried an unexpired auto-injector.…”

Section: Stock Eais In the School Settingmentioning

confidence: 99%

Epinephrine Auto-Injectors for Anaphylaxis Treatment in the School Setting: A Discussion Paper

Cooke

Meize-Grochowski

2019

SAGE Open Nursing

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Introduction: Anaphylaxis is a serious, life-threatening systemic allergic reaction that may occur in individuals not previously diagnosed with an allergy. Emergency first-line treatment of choice for acute anaphylaxis is intramuscular administration of epinephrine via an auto-injector. In the school setting, students with known allergies typically keep or carry an epinephrine auto-injector (EAI). For students who do not have a known allergy or for those whose personal EAIs are unavailable, an anaphylactic event could have serious adverse outcomes if an EAI is not available via an undesignated stock supply in the school. Methods: We searched the published literature from 2000 through 2018 in CINAHL, MEDLINE, and PubMed using the following search terms: anaphylaxis, school setting, epinephrine auto-injector, and food allergies. Throughout this article, undesignated stock EAIs, stock EAIs, EAI stock, and open-order EAIs are used interchangeably. Conclusion: Anaphylaxis is increasing worldwide as the incidence of food allergies increases. Although stock EAIs for students in schools can have important benefits, the availability of EAIs in the school setting is limited. Barriers to undesignated stock EAIs include the lengthy administrative process for developing school policies and protocols; gaps in nurses’ self-perceived knowledge versus objective knowledge on the topic of anaphylaxis; limited resources in many school districts; and complex role demands, lack of confidence in trained staff, or insufficient school nurse staffing. It is important that epinephrine be readily available in schools. Barriers to facilitating stock EAIs include those that can be addressed directly by nurses and those that may require policy changes. Nurses, particularly those working in school settings or pediatrics, could take the lead in discussions about the benefits of stock EAIs in schools, advocating for policy changes as warranted. Fully informed nurses can be better prepared to serve as advocates in ensuring that EAIs are available in school settings.

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Section: Stock Eais In the School Settingmentioning

confidence: 99%

Epinephrine Auto-Injectors for Anaphylaxis Treatment in the School Setting: A Discussion Paper

Cooke

Meize-Grochowski

2019

SAGE Open Nursing

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“…Patients/carers may benefit from an anaphylaxis management plan which can also be shared with school, work, etc. [ 30 ] with clear written instructions of how to manage an acute attack [ 1 ••, 2 ••, 3 ••, 4 ••]. It is important to clearly record the diagnosis in the patient’s notes and wearing emergency jewelry (e.g., a MedicAlert bracelet) should be encouraged [ 1 ••, 2 ••, 3 ••, 4 ••] so as to alert first-responders to administer epinephrine.…”

Section: Treatmentmentioning

confidence: 99%

Idiopathic Anaphylaxis

Nwaru

Dhami

Sheikh

2017

Curr Treat Options Allergy

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Opinion statementIdiopathic anaphylaxis is a rare life-threatening disorder with symptoms similar to other forms of anaphylaxis. There is lack of a robust evidence base underpinning the treatment of anaphylaxis and even less so for idiopathic anaphylaxis. Much of the evidence therefore comes from relatively small case series and expert opinion. Idiopathic anaphylaxis is a diagnosis of exclusion, requiring a thorough history and careful diagnostic work-up investigating possible triggers and underlying predisposing factors. Key diagnostic tests include skin-prick testing, tests for specific-IgE, component-resolved diagnostics, and in some cases for allergen challenge tests. Other recognized causes of anaphylaxis, such as foods, medications, insect stings, latex, and exercise, should all be considered, as should differential diagnoses such as asthma. While the cause of idiopathic anaphylaxis remains unknown, prompt treatment with intramuscular epinephrine (adrenaline) administered into the anterolateral aspect of the thigh is associated with good prognosis. There may also be a role for H1-antihistamines and corticosteroids as second-line agents. Patients need to be carefully monitored for signs of deterioration and/or a possible protracted or biphasic reaction. Patients with frequent episodes of anaphylaxis (e.g., six or more episodes/year) should be considered for preventive therapy, which may include corticosteroids, H1- and H2-antihistamines, and, in some cases, mast cell stabilizers such as ketotifen. Alternative immune-suppressants (e.g., methotrexate) and anti-IgE may rarely also need to be considered. In many cases, the frequency of anaphylaxis declines such that regular use of corticosteroids can be discontinued after 9–12 months. Pediatric patients should be treated with similar regimens as adults, but with appropriate dose adjustments. Patients should carry their self-injectable epinephrine and other emergency medications at all times in order to deal with emergency situations.

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Prevention of Anaphylaxis Based on Risk Factors and Cofactors

Thong

2016

Curr Treat Options Allergy

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Anaphylaxis in adolescents

Cited by 9 publications

References 27 publications

Epinephrine Auto-Injectors for Anaphylaxis Treatment in the School Setting: A Discussion Paper

Epinephrine Auto-Injectors for Anaphylaxis Treatment in the School Setting: A Discussion Paper

Idiopathic Anaphylaxis

Prevention of Anaphylaxis Based on Risk Factors and Cofactors

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