Food-Allergic Adolescents at Risk for Anaphylaxis: A Randomized Controlled Study of Supervised Injection to Improve Comfort with Epinephrine Self-Injection

Shemesh, Eyal; D’Urso, Christine; Knight, Christopher; Rubes, Melissa; Picerno, Kinga M.; Posillico, Ailie M.; Atal, Zara; Annunziato, Rachel A.; Sicherer, Scott H.

doi:10.1016/j.jaip.2016.12.016

Cited by 42 publications

(25 citation statements)

References 25 publications

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“…Furthermore, the improvements in HRQL and self-efficacy were sustained for at least 1 year, in contrast to previous data demonstrating the loss of effect over time. 23 Shemesh et al 33 reported that in a clinic setting, self-injection with an empty needle and syringe improved a young person’s confidence to use their AAI. To our knowledge, ours is the first systematic analysis of self-administration of AAI during in-hospital anaphylaxis on HRQL and self-efficacy.…”

Section: Discussionmentioning

confidence: 99%

Self-administration of adrenaline for anaphylaxis during in-hospital food challenges improves health-related quality of life

et al. 2020

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ObjectiveTo assess the impact of anaphylaxis on health-related quality of life (HRQL) and self-efficacy in food-allergic patients undergoing in-hospital food challenge.DesignSecondary analysis of a randomised controlled trial.SettingSpecialist allergy centre.PatientsPeanut-allergic young people aged 8–16 years.InterventionsDouble-blind, placebo-controlled food challenge to peanut, with HRQL and self-efficacy assessed using validated questionnaire, approximately 2 weeks prior to and 2 weeks after challenge. Where possible, anaphylaxis was treated with self-injected adrenaline (epinephrine).Main outcome measuresChange in HRQL and self-efficacy.Results56 participants had reactions at food challenge, of whom 16 (29%) had anaphylaxis. Overall, there was an improvement in HRQL (mean 2.6 points (95% CI 0.3 to 4.8); p=0.030) and self-efficacy (mean 4.1 points (95% CI 2.4 to 5.9); p<0.0001), independent of whether anaphylaxis occurred. Parents also reported improved HRQL (mean 10.3 points (95% CI 5.9 to 14.7); p<0.0001). We found evidence of discordance between the improvement in HRQL and self-efficacy as reported by young people and that perceived by parents in their child.ConclusionsAnaphylaxis at food challenge, followed by self-administration of injected adrenaline, was associated with an increase in HRQL and self-efficacy in young people with peanut allergy. We found no evidence that the occurrence of anaphylaxis had a detrimental effect. Young people should be encouraged to self-administer adrenaline using their autoinjector device to treat anaphylaxis at in-hospital challenge.Trial registration numberNCT02149719

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Section: Discussionmentioning

confidence: 99%

Self-administration of adrenaline for anaphylaxis during in-hospital food challenges improves health-related quality of life

et al. 2020

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“…8 Some of the reluctance can be related to fears of needles and side effects of the medication. 162 Shemesh et al 163 performed an intervention in which adolescents practiced selfinjection with an empty needle/syringe to address needle phobia and found significant improvement in comfort with selftreatment.…”

Section: Managementmentioning

confidence: 99%

Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management

Sicherer

Sampson

2018

Journal of Allergy and Clinical Immunology

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1,283

977

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This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis, and treatment that have occurred over the 4 years since our last comprehensive review. Although firm prevalence data are lacking, there is a strong impression that food allergy has increased, and rates as high as approximately 10% have been documented. Genetic, epigenetic, and environmental risk factors are being elucidated increasingly, creating potential for improved prevention and treatment strategies targeted to those at risk. Insights on pathophysiology reveal a complex interplay of the epithelial barrier, mucosal and systemic immune response, route of exposure, and microbiome among other influences resulting in allergy or tolerance. The diagnosis of food allergy is largely reliant on medical history, tests for sensitization, and oral food challenges, but emerging use of component-resolved diagnostics is improving diagnostic accuracy. Additional novel diagnostics, such as basophil activation tests, determination of epitope binding, DNA methylation signatures, and bioinformatics approaches, will further change the landscape. A number of prevention strategies are under investigation, but early introduction of peanut has been advised as a public health measure based on existing data. Management remains largely based on allergen avoidance, but a panoply of promising treatment strategies are in phase 2 and 3 studies, providing immense hope that better treatment will be imminently and widely available, whereas numerous additional promising treatments are in the preclinical and clinical pipeline.

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“…Improving access to clear and concise educational materials would likely reduce stress/anxiety and improve QoL since it may increase parents' sense of control. 42,91 A parental calm, matter-of-fact approach to FA management focusing on safety routines and model use of adaptive coping, may convey the message that FA is manageable. 42 For some parents, participation in support groups with other families with FA may reduce burden by normalizing experiences.…”

Section: Interventions For Anxiety In Famentioning

confidence: 99%

Anxiety and food allergy: A review of the last two decades

Polloni

Muraro

2020

Clin Experimental Allergy

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Food allergy (FA) is recognized as a growing public health burden affecting 5%‐10% of children worldwide. Several unique features specific to FA elicit high levels of emotional distress and anxiety in patients and caregivers, the first among all the possibility of a life‐threatening reaction. Anxiety disorders are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health. This review aimed to offer a comprehensive overview of literature data on FA and anxiety of the last two decades. A review of the medical and psychological literature from the year 2000 (MEDLINE, PubMed and PsycINFO) was done using the keywords “anxiety” and “food allergy.” Clinical implications for disease management, various manifestations in different target groups, proper interventions and possible explanations on the nature of the association between FA and anxiety have been discussed, as well as limitations and further research directions. The relationship between FA and anxiety is attributed to FA‐specific fears and anxiety, rather than a general propensity towards anxiety. Some anxiety—short‐lived and related to key events–is to be expected and may even be helpful if it sustains allergen avoidance and preparedness to emergency. However, some data reported that increased anxiety did not improve adherence. Rather, high levels of anxiety have been demonstrated counterproductive and related to maladaptive coping. Further research is needed to elucidate the association between FA and anxiety, especially to understand biopsychosocial directions of the underlying mechanisms and to build proper, effective, standardized protocols of intervention. Clinicians must be aware of the association between FA and anxiety, understand their role in recognizing maladaptive anxiety and encouraging to seek psychological support when needed.

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Food-Allergic Adolescents at Risk for Anaphylaxis: A Randomized Controlled Study of Supervised Injection to Improve Comfort with Epinephrine Self-Injection

Cited by 42 publications

References 25 publications

Self-administration of adrenaline for anaphylaxis during in-hospital food challenges improves health-related quality of life

Self-administration of adrenaline for anaphylaxis during in-hospital food challenges improves health-related quality of life

Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management

Anxiety and food allergy: A review of the last two decades

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