JOURNAL CLUB: Benefit of Epinephrine Autoinjector for Treatment of Contrast Reactions: Comparison of Errors, Administration Times, and Provider Preferences

Asch, Daniella; Pfeifer, Kyle; Arango, Jennifer; Staib, Lawrence H.; Cavallo, Joseph J.; Kirsch, John A. W.; Arici, Melih; Pahade, Jay

doi:10.2214/ajr.16.17111

Cited by 13 publications

(10 citation statements)

References 21 publications

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“…Strength of recommendation: This is a conditional recommendation for using autoinjectors because the certainty of evidence is very low due to the available trials being at moderate or high risk of bias. 55,56 Practical 3 for arguments for prescribing one or two devices). In many countries, adrenaline autoinjectors are not available or not affordable or there are supply issues with adrenaline autoinjectors.…”

Section: Adrenaline Autoinjector or Needle-syringementioning

confidence: 99%

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EAACI guidelines: Anaphylaxis (2021 update)

Muraro¹,

Worm

Alviani

et al. 2021

Allergy

328

288

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Antonella Muraro, Margitta Worm and Graham Roberts equally contributed as guideline chairs.This paper sets out the updated European Academy of Allergy and Clinical Immunology's (EAACI) guideline regarding the diagnosis, acute management, and prevention of anaphylaxis. Anaphylaxis is a clinical emergency and all healthcare professionals need to be familiar with its recognition and management. Anaphylaxis is a lifethreatening reaction characterized by acute onset of symptoms involving different organ systems and requiring immediate medical intervention. 1 Although the fatality rate due to anaphylaxis remains low, 2 the frequency of hospitalization from food and drug-induced anaphylaxis has been increasing in recent years. 3 The symptoms of anaphylaxis are highly variable. 4,5 Data from patients experiencing anaphylaxis revealed that skin and mucosal symptoms occur most frequently (>90% of cases) followed by symptoms involving the respiratory and cardiovascular systems (>50%). Food, drug, and Hymenoptera venom are the most common elicitors of anaphylactic reactions. 5,6 The prevalence of the various causes of anaphylaxis are age-dependent and vary in different geographical regions. In Europe, typical causes of food-induced anaphylaxis in children are peanut, hazelnut, milk, and egg and in adults, wheat, celery, and shellfish; fruits such as peach are also typical causes of food-induced anaphylaxis in adults in some European countries such as Spain and Italy. 7,8 Venom-induced anaphylaxis is typically caused by wasp and bee venom. 9 Drug-induced anaphylaxis is typically caused by antibiotics and non-steroidal anti-inflammatory drugs. 10,11 Among antibiotics, beta-lactam antibiotics are the leading eliciting allergens. 12 At times, there is an occupational cause. 13 Co-factors may be aggravating factors in anaphylaxis, examples are exercise, stress, infection, non-steroidal anti-inflammatory drugs, and alcohol. [14][15][16] In some cases, the cause is not obvious (idiopathic anaphylaxis) and investigations for rarer allergens or differential diagnoses should be considered. [17][18][19] This guideline, updated from 2014, 20 provides evidence-based guidance to help manage anaphylaxis. The primary audience is clinical allergists (specialists and subspecialists), primary care, paediatricians, emergency physicians, anaesthetists and intensivists, nurses, dieticians, and other healthcare professionals. The guideline was

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Section: Adrenaline Autoinjector or Needle-syringementioning

confidence: 99%

Section: Emergency Management Of Anaphylaxismentioning

confidence: 99%

EAACI guidelines: Anaphylaxis (2021 update)

Muraro¹,

Worm

Alviani

et al. 2021

Allergy

328

288

View full text Add to dashboard Cite

show abstract

“… 47 A study with radiologists found that using an AAI reduced the time to administration by an average of 70 s compared to drawing up manually from an ampoule, and resulted in fewer administration errors. 48 Most AAIs deliver a maximum of 300 micrograms epinephrine, while the appropriate dose in teenagers and adults is 500 micrograms. Coronial inquests have identified that the use of AAIs for anaphylaxis can therefore result in substantial underdosing, which may contribute to fatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

Evidence update for the treatment of anaphylaxis

et al. 2021

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The Resuscitation Council UK has updated its Guideline for healthcare providers on the Emergency treatment of anaphylaxis. As part of this process, an evidence review was undertaken by the Guideline Working Group, using an internationally-accepted approach for adoption, adaptation, and de novo guideline development based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence to decision (EtD) framework, referred to as GRADE-ADOLOPMENT. A number of significant changes have been made, which will be reflected in the updated Guideline.These include: emphasis on repeating intramuscular adrenaline doses after 5 min if symptoms of anaphylaxis do not resolve; corticosteroids (e.g. hydrocortisone) no longer being routinely recommended for the emergency treatment of anaphylaxis; interventions for reactions which are refractory to initial treatment with adrenaline; a recommendation against the use of antihistamines for the acute management of anaphylaxis; and guidance relating to the duration of observation following anaphylaxis, and timing of discharge.

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“…In a nonrandomized trial, health professionals tested an autoinjector or a syringe (not prefilled). Using an autoinjector reduced the time to administration by an average of 70 seconds compared to a syringe and resulted in fewer administration errors (statistically significant, confidence intervals not reported, very low certainty, Appendix g) 42 …”

Section: Resultsmentioning

confidence: 99%

Diagnosing, managing and preventing anaphylaxis: Systematic review

Silva¹,

Singh²,

Muraro³

et al. 2020

Allergy

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Background This systematic review used the GRADE approach to compile evidence to inform the European Academy of Allergy and Clinical Immunology's (EAACI) anaphylaxis guideline. Methods We searched five bibliographic databases from 1946 to 20 April 2020 for studies about the diagnosis, management and prevention of anaphylaxis. We included 50 studies with 18 449 participants: 29 randomized controlled trials, seven controlled clinical trials, seven consecutive case series and seven case‐control studies. Findings were summarized narratively because studies were too heterogeneous to conduct meta‐analysis. Results It is unclear whether the NIAID/FAAN criteria or Brighton case definition are valid for immediately diagnosing anaphylaxis due to the very low certainty of evidence. There was also insufficient evidence about the impact of most anaphylaxis management and prevention strategies. Adrenaline is regularly used for first‐line emergency management of anaphylaxis but little robust research has assessed its effectiveness. Newer models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce time to administration. Face‐to‐face training for laypeople may slightly improve anaphylaxis knowledge and competence in using autoinjectors. We searched for but found little or no comparative effectiveness evidence about strategies such as fluid replacement, oxygen, glucocorticosteroids, methylxanthines, bronchodilators, management plans, food labels, drug labels and similar. Conclusions Anaphylaxis is a potentially life‐threatening condition but, due to practical and ethical challenges, there is a paucity of robust evidence about how to diagnose and manage it.

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JOURNAL CLUB: Benefit of Epinephrine Autoinjector for Treatment of Contrast Reactions: Comparison of Errors, Administration Times, and Provider Preferences

Abstract: Use of an epinephrine autoinjector for treatment of contrast reactions was associated with a significantly greater degree of provider comfort, shorter time to administration, and fewer errors.

Cited by 13 publications

References 21 publications

EAACI guidelines: Anaphylaxis (2021 update)

EAACI guidelines: Anaphylaxis (2021 update)

Evidence update for the treatment of anaphylaxis

Diagnosing, managing and preventing anaphylaxis: Systematic review

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