Availability of the epinephrine autoinjector at school in children with peanut allergy

Anaphylaxis occurs commonly in community settings. The rate of occurrence is increasing, especially in young people. Understanding potential triggers, mechanisms, and patient-specific risk factors for severity and fatality is the key to performing appropriate risk assessment in those who have previously experienced an acute anaphylactic episode. The diagnosis of anaphylaxis is based primarily on clinical criteria and is valid even if the results of laboratory tests, such as serum total tryptase levels, are within normal limits. Positive skin test results or increased serum specific IgE levels to potential triggering allergens confirm sensitization but do not confirm the diagnosis of anaphylaxis because asymptomatic sensitization is common in the general population. Important patient-related risk factors for severity and fatality include age, concomitant diseases, and concurrent medications, as well as other less well-defined factors, such as defects in mediator degradation pathways, fever, acute infection, menses, emotional stress, and disruption of routine. Prevention of anaphylaxis depends primarily on optimal management of patient-related risk factors, strict avoidance of confirmed relevant allergen or other triggers, and, where indicated, immunomodulation (eg, subcutaneous venom immunotherapy to prevent Hymenoptera sting-triggered anaphylaxis, an underused, potentially curative treatment). The benefits and risks of immunomodulation to prevent food-triggered anaphylaxis are still being defined. Epinephrine (adrenaline) is the medication of first choice in the treatment of anaphylaxis. All patients at risk for recurrence in the community should be equipped with 1 or more epinephrine autoinjectors; a written, personalized anaphylaxis emergency action plan; and up-to-date medical identification. Improvements in the design of epinephrine autoinjectors will help to optimize ease of use and safety. Randomized controlled trials of pharmacologic agents, such as antihistamines and glucocorticoids, are needed to strengthen the evidence base for treatment of acute anaphylactic episodes.

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“…192 Lack of access to epinephrine autoinjectors for children experiencing anaphylaxis in schools remains a concern. 188,189,193,194 …”

Section: Long-term Risk Reduction: Prevention Of Anaphylaxismentioning

confidence: 99%

Anaphylaxis

Simons

2010

Journal of Allergy and Clinical Immunology

397

380

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“…The authors concluded that there is much need for patient education to increase AAI use in anaphylaxis. A similar study in 271 children with peanut allergy (in Quebec, Canada) (65) revealed that 48% of the children did not carry their AAI with them in school. Those children who were more likely to carry their AAI with them at school had been previously administered adrenaline for a reaction (odds ratio [OR], 2.7), were older children (OR, 1.1) or were those living only with their mother (OR, 3.4).…”

Section: Failure To Use Aais By Patientsmentioning

confidence: 85%

Anaphylaxis treatment: current barriers to adrenaline auto-injector use

Song

Worm

Lieberman

2014

Allergy

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To cite this article: Song TT, Worm M, Lieberman P. Anaphylaxis treatment: current barriers to adrenaline auto-injector use. AbstractAnaphylaxis is a life-threatening condition that is increasing in prevalence in the developed world. There is universal expert agreement that rapid intramuscular injection of adrenaline is life-saving and constitutes the first-line treatment of anaphylaxis. The unpredictable nature of anaphylaxis and its rapid progression makes necessary the availability of a portable emergency treatment suitable for self-administration. Thus, anaphylaxis treatment guidelines recommend that at-risk patients are provided with adrenaline auto-injectors (AAIs). Despite these clear recommendations, current emergency treatment of anaphylaxis continues to be inadequate in many cases. The aim of this review is to highlight the barriers that exist to the use and availability of AAIs and that prevent proper management of anaphylaxis. In addition, we review the characteristics of all AAIs that are presently available in Europe and the USA and discuss the need for regulatory requirements to establish the performance characteristics of these devices.

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“…In our study, atopy was defined as a positive allergen-specific serum IgE test or skin prick test to any common food or inhalant allergens [9]. As previously described [10], a diagnosis of food allergy was established only if one of the following conditions was fulfilled: (1) the child had both a convincing clinical history of an allergic reaction and a positive skin prick test, or food-specific IgE ≥0.35 kU/l, and (2) the child had never or rarely ingested the food or had an uncertain clinical history of an allergic reaction to the food but had (a) a specific IgE greater than or equal to the cutoff of 15 kU/l for milk, peanut, and tree nut and 20 kU/l for fish, or (b) a positive food challenge as previously described [10]. …”

Section: Methodsmentioning

confidence: 99%

Altered T Helper 17 Responses in Children with Food Allergy

Dhuban

d’Hennezel

Ben‐Shoshan³

et al. 2013

Int Arch Allergy Immunol

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Background: While a central role for the T helper (Th) 1/Th2 axis in food allergy has been established, the Th17 response in food-allergic humans has not been addressed. Methods: Th17 responses in 18 peanut-allergic children, who were also allergic to at least one additional food allergen, were assessed relative to 15 age-matched healthy controls. To account for the atopy background in the allergic children, 7 atopic, but not food-allergic, individuals and their age-matched controls were included in this study. PBMCs were analyzed by flow cytometry ex vivo or were stimulated in vitro with peanut allergens, gliadin, or tetanus toxoid followed by analysis of proliferation and cytokine production in antigen-responsive cells. Results: We observed a significantly lower interleukin (IL) 17 production in CD4+ T cells of food-allergic individuals ex vivo (p < 0.02). In vitro, we found that IL-17 production in CD4+ T cells in response to all antigens tested was significantly impaired in food-allergic subjects compared to healthy controls (Ara: p < 0.005; gliadin: p < 0.004; TT: p < 0.03). No significant differences were observed between atopic and nonatopic individuals with no food allergy. Conclusion: Our results thus reveal a systemic, non-allergen-specific defect in Th17 responses to antigen stimulation in food allergic individuals, suggesting a role for Th17 cells in the control of food allergy and implicating IL-17 as a potential biomarker for tolerance to food antigens.

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Availability of the epinephrine autoinjector at school in children with peanut allergy

Cited by 49 publications

References 44 publications

Anaphylaxis

Anaphylaxis

Anaphylaxis treatment: current barriers to adrenaline auto-injector use

Altered T Helper 17 Responses in Children with Food Allergy

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