Proximity-Based Emergency Response Communities for Patients With Allergies Who Are at Risk of Anaphylaxis: Clustering Analysis and Scenario-Based Survey Study

Abstract

Background Anaphylaxis is a potentially fatal allergic reaction. However, many patients at risk of anaphylaxis who should permanently carry a life-saving epinephrine auto injector (EAI) do not carry one at the moment of allergen exposure. The proximity-based emergency response communities (ERC) strategy suggests speeding EAI delivery by alerting patient-peers carrying EAI to respond and give their EAI to a nearby patient in need. Objectives This study had two objectives: (1) to analyze 10,000 anaphylactic events from the European Anaphylaxis Registry (EAR) by elicitor and location in order to determine typical anaphylactic scenarios and (2) to identify patients’ behavioral and spatial factors influencing their response to ERC emergency requests through a scenario-based survey. Methods Data were collected and analyzed in two phases: (1) clustering 10,000 EAR records by elicitor and incident location and (2) conducting a two-center scenario-based survey of adults and parents of minors with severe allergy who were prescribed EAI, in Israel and Germany. Each group received a four-part survey that examined the effect of two behavioral constructs—shared identity and diffusion of responsibility—and two spatial factors—emergency time and emergency location—in addition to sociodemographic data. We performed descriptive, linear correlation, analysis of variance, and t tests to identify patients’ decision factors in responding to ERC alerts. Results A total of 53.1% of EAR cases were triggered by food at patients’ home, and 46.9% of them were triggered by venom at parks. Further, 126 Israeli and 121 German participants completed the survey and met the inclusion criteria. Of the Israeli participants, 80% were parents of minor patients with a risk of anaphylaxis due to food allergy; their mean age was 32 years, and 67% were women. In addition, 20% were adult patients with a mean age of 21 years, and 48% were female. Among the German patients, 121 were adults, with an average age of 47 years, and 63% were women. In addition, 21% were allergic to food, 75% were allergic to venom, and 2% had drug allergies. The overall willingness to respond to ERC events was high. Shared identity and the willingness to respond were positively correlated (r=0.51, P<.001) in the parent group. Parents had a stronger sense of shared identity than adult patients (t243= –9.077, P<.001). The bystander effect decreased the willingness of all patients, except the parent group, to respond (F1,269=28.27, P<.001). An interaction between location and time of emergency (F1,473=77.304, P<.001) revealed lower levels of willingness to respond in strange locations during nighttime. Conclusions An ERC allergy app has the potential to improve outcomes in case of anaphylactic events, but this is dependent on patient-peers’ willingness to respond. Through a two-stage process, our study identified the behavioral and spatial factors that could influence the willingness to respond, providing a basis for future research of proximity-based mental health communities.

Peanut‐induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry

“…Only 36% of the peanut anaphylactic reactions and 40% of the reactions triggered by other food were initially treated by a lay person, including self‐administration of im adrenaline. There was no statistically significant difference between subgroups regarding self‐administration of im adrenaline, but failure to apply/carry an adrenaline auto‐injector was registered in 44% of peanut anaphylaxis and in 53% of the cases allergic to other food, which matches the reports of studies evaluating real‐world use of AAI 24 . In a community‐based survey uncertainty about the severity of the reaction, fear of side effects, and difficulties deciding which drugs to use were identified as reasons for not applying AAIs 25 …”

“…There was no statistically significant difference between subgroups regarding self-administration of im adrenaline, but failure to apply/carry an adrenaline auto-injector was registered in 44% of peanut anaphylaxis and in 53% of the cases allergic to other food, which matches the reports of studies evaluating real-world use of AAI. 24 In a community-based survey uncertainty about the severity of the reaction, fear of side effects, and difficulties deciding which drugs to use were identified as reasons for not applying AAIs. 25 Professional emergency treatment was mainly carried out by an emergency physician.…”

Peanut induced anaphylaxis in children and adolescents: data from the European Anaphylaxis Registry

“…There was no statistically significant difference between subgroups regarding self-administration of i.m. adrenaline, but failure to apply/carry an adrenaline auto-injector was registered in 44% of peanut anaphylaxis and in 53% of the cases allergic to other food, which matches the reports of studies evaluating real-world use of AAI (25). In a communitybased survey uncertainty about the severity of the reaction, fear of side effects, and difficulties deciding which drugs to use were identified as reasons for not applying AAIs (26).…”

A Cost-Effectiveness Analysis of Epinephrine Autoinjector Risk Stratification for Patients with Food Allergy—One Epinephrine Autoinjector or Two?

“…Moreover, such a strategy combined with the use of community-based device sharing technology may provide more benefit than the status quo of two devices. (32,33) In this respect, we did not consider additional risk reduction from existing shared community epinephrine resources (e.g., schools, commercial aircraft) (21, 22) making a universal approach even less cost-effective. Third, in the base case, we assumed a 12% rate of needing a 2 nd dose of epinephrine based on history; however, sensitivity analyses of rising rates showed a universal strategy becomes more cost-effective.…”