Search

Background: Anaphylaxis is a serious systemic allergic disease that often mani-fests with a broad array of symptoms and leads to death if not immediately treated by the administration of epinephrine auto-injector (EAI). Aims and objectives: To assess EAI dispense as an indicator to estimate anaphylaxis in Qatar, to determine the common causes of anaphylaxis in Qatar, to dissect the clinical profile of patients, and to determine the comorbidity factors in patients with anaphylaxis in Qatar. Methods: A retrospective study conducted using 1,068 electronic medical records (EMR) of anaphylaxis patients through the period of 2012 to 2016. The majority of the patients were collected from dispensed EAIs of outpatients (622) and the remainder (446) were from ICD-10 codes. To assess the feasibility of using the dispensed EAIs as possible measure for anaphylaxis, we calculated the sensitivity and specificity of this test on our patients’ cohort (1,068). The demographics data, triggers, co-morbidity factors, symptoms, and clinical manifestations were catego-rized and thoroughly analyzed. Statistical analysis was performed with version 24 SPSS statistic software package. Results: The sensitivity of dispensed EAIs to detect anaphylaxis was 87.0% with positive predictive value (PPV) of 80%. There were 574 patients (53.5%) diagnosed with anaphylaxis, male to female ratio was 1.2, and 300 patients (77.9%) were less than ten years. Food was the leading trigger of anaphylaxis (n=316, 55.0%) followed by insect stings (n=161, 28.0%) and drugs (n=103, 17.9%). Asthma (n=208, 36.2%), atopic dermatitis (n= 195, 33.9%) and allergic rhinitis (n=81, 14.1%) were the common comor-bidity factors that significantly associated with anaphylaxis. Symptoms included 87.9% cutaneous, 69.1% respiratory, 47.5% gastrointestinal, 15.8% cardiac, and 8.8% neurologi-cal. Patients treated without the use of EAIs (n=143, 77.7%) were exposed to more serious adverse events including two deaths and one shock. Conclusion: This study will serve as a clinical guide for clinicians at allergic and pediatrics clinics and might be used as a base-line to assess the future trend of anaphylaxis in Qatar.

We investigated the effectiveness of epinephrine auto‐injector (EpiPen®) skill training for Yogo teachers in the community medicine. The auto‐injector skill training might be effective for establishing a caring system for anaphylaxis at schools in the context of community medicine.

The systematic application of human factors engineering (HFE) principles to the development of drug-device combination products, including epinephrine auto-injectors (EAIs), has the potential to improve the effectiveness and safety of drug administration.A PubMed search was performed to assess the role of HFE in the development of drug-device combination products. The following keywords were used in different combinations: 'human factors engineering,' 'human factors,' 'medical products,' 'epinephrine/adrenaline auto-injector,' 'healthcare' and 'patient safety.' This review provides a summary of HFE principles and their application to the development of drug-device combination products as advised by the US FDA. It also describes the HFE process that was applied to the development of Auvi-Q, a novel EAI, highlighting specific steps that occurred during the product-development program.For drug-device combination products, device labeling and usability are critical and have the potential to impact clinical outcomes. Application of HFE principles to the development of drug-delivery devices has the potential to improve product quality and reliability, reduce risk and improve patient safety when applied early in the development process. Additional clinical and real-world studies will confirm whether the application of HFE has helped to develop an EAI that better meets the needs of patients at risk of anaphylaxis.

Epinephrine auto-injectors are used for first aid in anaphylactic emergencies by non-healthcare professionals, e.g., (pre-)school teachers. We developed an education session for preschool teachers addressing allergies, anaphylactic emergencies, and administering auto-injectors. We assessed their attitudes and knowledge in allergies and anaphylactic emergency by a questionnaire and monitored their practical performance in administering auto-injectors before the education session, directly after, and 4-12 weeks after the session. From 75 teachers giving their consent to participate, 81% had children with allergies under their supervision and 3% had already administered medication from an available rescue kit. The knowledge of triggers of allergies increased from 9 to 55% directly and to 33% 4-12 weeks after the session (both p 0.001, compared to baseline). Directly after the session, the number of teachers who felt well-prepared for an anaphylactic emergency rose from 11 to 88%, which decreased to 79% 4-12 weeks thereafter (each p 0.001). The number of auto-injector administrations without any drug-related problems increased from 3 to 35% directly after the session and shrunk to 16% 4-12 weeks afterwards (both p 0.025).A single education session substantially improved preschool teachers' attitudes and knowledge in allergies and anaphylactic emergencies. Additionally, their practical performance in auto-injector administration increased. What is Known: • Food allergies are increasing among children. • The knowledge about allergies and anaphylactic emergencies is poor. What is New: • The proportion of teachers who felt well-prepared for an anaphylactic emergency increased after a single education session. • The proportion of auto-injector administrations without any drug-related problems additionally increased due to an education session.

Background Successful treatment of anaphylaxis in the community relies on early and correct use of epinephrine auto-injectors (EAI). In the Netherlands pharmacists supply EAIs to patients and have a crucial role in instructing patients in how and when to use EAI. However, there are currently no data in Europe on the quality of such instruction provided by pharmacists. Therefore, the aims of this study were to investigate the knowledge, attitudes, and beliefs regarding food allergy among pharmacists in the Netherlands, and to investigate the quality of EAI instructions and demonstrations to patients by pharmacists. Methods Pharmacists were asked to complete an online questionnaire. Quality of instructions and demonstration accuracy were assessed in mystery guest visits to randomly selected pharmacies. For the statistical analysis descriptive methods were used. Results In total 25 out of 115 questionnaires were completed. Only two (8%) respondents gave correct answers concerning the proper EAI demonstration. Twenty-one (84%) respondents thought that the provision of instructions was the responsibility of pharmacists. In total, ten pharmacies were included in simulated patient visits. Five of them (50%) demonstrated the EAI. None of them demonstrated the EAI use correctly. Conclusion Food-allergic patients at high risk for anaphylaxis who receive their EAI from a community pharmacy are often not instructed on how to use an EAI or receive incorrect instructions. Pharmacists show considerable gaps in knowledge about food allergy and its management. These data suggest that opportunities exist to improve the quality of care provided by pharmacies to high risk food-allergic patients. This article is protected by copyright. All rights reserved.

Background: Epinephrine is the only first-line therapeutic agent used to treat life-threatening anaphylaxis. Epinephrine auto-injectors are commonly carried by patients at risk for anaphylaxis, and reported cases of unintentional auto-injector injury have increased over the last decade. Modifications of existing designs and release of a new style of auto-injector are intended to reduce epinephrine auto-injector misuse. Study Question: The aim of the study was to characterize reported cases of unintentional epinephrine auto-injector exposures from 2013 to 2014 and compare demographics, auto-injector model, and anatomical site of such exposures. Methods: The American Association of Poison Control Center's National Poison Data System was searched from January 1, 2013, to December 31, 2014, for cases of unintentional epinephrine auto-injector exposures. Anatomical site data were obtained from all cases reported to the Virginia Poison Center and participating regional poison center for Auvi-Q cases. Results: A total of 6806 cases of unintentional epinephrine auto-injector exposures were reported to US Poison Centers in 2013 and 2014. Of these cases, 3933 occurred with EpiPen, 2829 with EpiPen Jr, 44 with Auvi-Q, and no case reported of Adrenaclick. The most common site of unintentional injection for traditional epinephrine auto-injectors was the digit or thumb, with 58% of cases for EpiPen and 39% of cases with EpiPen Jr. With Auvi-Q, the most common site was the leg (78% of cases). Conclusions: The number of unintentional epinephrine auto-injector cases reported to American Poison Centers in 2013–2014 has increased compared with previous data. Most EpiPen exposures were in the digits, whereas Auvi-Q was most frequently in the leg. Because of the limitations of Poison Center data, more research is needed to identify incidence of unintentional exposures and the effectiveness of epinephrine auto-injector redesign.

Introduction Epinephrine auto-injectors (EAIs) typically require storage temperatures between 20-25°C with permitted excursions between 15°-30°C. However, previous studies suggest that freezing does not degrade epinephrine, and in one study 10 frozen and thawed EAIs fired successfully. We aim to further explore the effects of freezing on EAI function. Methods For 104 paired same-lot post-consumer single-common-brand expired EAIs (50 0.3 mg and 50 0.15 mg devices), one of the pair was frozen at -25°C for 24 hours while the other was kept at recommended temperatures (control). After thawing the frozen device, both devices were fired into meat. The increase in meat mass and decrease in device mass were measured to estimate the mass of solution fired. Results There was sufficient power (>95%) to conclude equivalence for both outcomes, defined as equivalent if the average difference in mass for frozen devices was within 10% of the difference for unfrozen devices. Two one-sided t-tests showed equivalence for both outcomes (p value Conclusions Freezing for 24 hours did not impair EAI device's function once thawed. While freezing is not recommended, devices accidentally left in freezing temperatures for short periods are at low risk for malfunction.

Background Accurate estimates of the incidence of anaphylaxis are limited. Current International Classification of Diseases, Ninth Revision ( ICD-9 ) codes complicate accurate diagnosis of anaphylaxis and assessment of appropriate epinephrine prescribing. Objective To quantify the incidence and demographic character of patients with anaphylaxis-related ICD-9 codes in a large health maintenance organization and analyze epinephrine prescribing and dispensing rates. Methods All patients included had at least 12 months of continuous membership over a 4-year period from January 1, 2008 to December 31, 2012 and were selected based on anaphylaxis-related ICD-9 codes (N = 159,172). This algorithm was extrapolated from a previous study that used expanded ICD-9 codes to identify more cases of anaphylaxis. Individual chart reviews found that many expanded ICD-9 codes represented unconfirmed cases of anaphylaxis and therefore were excluded, resulting in analysis of 52,405 patients. Results Incidence of anaphylaxis over 4 years was 2.07%, with female predominance (56.5%) over male predominance (43.5%). Epinephrine was prescribed in 16.2% of total cases. Highest rates of epinephrine prescription were for traditional ICD-9 codes 995.0 (other anaphylactic shock) and 995.60 to 995.69 (anaphylactic shock caused by food) at 49.3% and 58.6%, respectively. Of the cases in which an epinephrine auto-injector was prescribed, it was dispensed 95.9% of the time, independent of copayment amount. Conclusion Low epinephrine auto-injector prescribing rates in cases of anaphylaxis suggest the continued difficulty in the diagnosis of anaphylaxis and could result in suboptimal treatment of potential future episodes.

The purpose of this manuscript is to review the literature on the clinical effects of the needle length of epinephrine (adrenaline) auto-injectors.Epinephrine has maximal pharmacodynamic effect within 10 min of intramuscular administration into the thigh. Prefilled epinephrine auto-injectors are designed for simplicity of use and safety. Auto-injectors are primarily used by patients in an unsupervised setting in cases of anaphylaxis. There are weight-appropriate doses of epinephrine available with auto-injectors that are prefilled, to prevent dosing errors, with 0.15, 0.30, and 0.50 mg amounts. In addition, needle lengths vary from 1.17 to 2.50 cm. The recommended needle lengths differ between adults and pediatric patients. In addition, the needle lengths differ between devices as well. There are concerns that the needle length may be too short in select obese patients. Yet, there are also concerns that the needle length may be too long in some patients. Factors that affect the depth of the injection, and therefore the pharmacokinetics of the drug, include not only the needle length but also the BMI, obesity, compression of soft tissue, and propulsion.Epinephrine auto-injectors have different needle lengths. Using the right device with appropriate needle length based on BMI, obesity, and employing the proper technique can improve the outcome in an anaphylactic event.

Background: Food allergy is the most common cause of anaphylaxis in children. Intramuscular delivery of epinephrine auto-injectors (EAI) is the standard of care for the treatment of anaphylaxis. We examined if children and adolescents at risk of anaphylaxis weighing 15–30 kg and >30 kg would receive epinephrine into the intramuscular space with the currently available EAI in North America and Europe. Methods: The distance from skin to muscle (STMD) and skin to bone (STBD) on the mid third anterolateral area of the right thigh was measured by ultrasound applying either high pressure (max) or slight pressure (min) in 102 children weighing 15–30 kg (group 1) and 100 children and adolescents, weighing more than 30 kg (group 2). Results: Using a high pressure EAI (HPEAI), Epipen Jr® and Auvi-Q®/Allerject® 0.15 mg, 11/102 (11 %) children in group 1 and 38/102 (38 %) using another HPEAI, Jext®, had a STMDmax that showed a risk of intraosseous injection. There was a 1 % risk of subcutaneous injection with these devices. There was no risk of intraosseous injection using a low pressure EAI (LPEAI), Emerade®. In group 2, the risk of intraosseous injection using a HPEAI was 3 % and no risk using a LPEAI. However, the risk of subcutaneous injection using HPEAI was 9 % and using LPEAI was 2 %. Conclusion: There is a risk of intraosseous injection using HPEAI (Epipen®/Epipen Jr®, Auvi-Q®/Allerject® and especially Jext®) in children at risk of anaphylaxis. There was also a risk of subcutaneous injection using the currently available HPEAI in children and adolescents.

BackgroundFood-allergic patients at high risk of potential fatal anaphylaxis should carry an epinephrine auto-injector (EAI) at all times. This treatment may be perceived as burdensome and this may affect compliance and health-related quality of life (HRQL). The aims of the study were (1) to determine the burden of treatment (BoT) of an EAI, (2) to examine the relationship between this burden and compliance, and (3) to analyze which factors contribute to the BoT of the EAI as perceived by food-allergic adolescents and their parents.MethodsDutch food-allergic adolescents prescribed an EAI, and their parents completed a questionnaire package (n = 55). Relationships between BoT and HRQL, illness severity and perception, and anxiety measures were investigated.ResultsFood-allergic adolescents and their parents were (extremely) positive about the EAI (54.5%; 72.7%, respectively) (=low BoT). The BoT measure showed a significantly greater burden in food-allergic adolescents prescribed an EAI who reported not carrying the EAI at all times than adolescents who reported they did. The BoT scores of both adolescents and their parents were not associated with HRQL, illness severity and perception, or trait anxiety.ConclusionsThe majority of food-allergic adolescents and their parents were positive about the EAI (=low BoT). However, the BoT was significantly associated with self-reported compliance with carrying the EAI. The BoT was higher in food-allergic adolescents prescribed an EAI who reported not carrying the EAI at all times. The BoT measure seems to be a useful tool to study compliance with carrying an EAI. The BoT of an EAI is not associated with HRQL. The BoT measures a distinct concept related to compliance behavior.

Epinephrine is crucial in the treatment of anaphylaxis. As anaphylaxis frequently occurs in nonmedical settings, use of an epinephrine auto-injector is vital for prompt management. This article provides an overview of the increasing number of epinephrine auto-injector prescriptions and the underlying causes and contributing factors to these rising prescriptions. It also reviews the current indications for prescription of an epinephrine auto-injector, proper use of epinephrine auto-injectors, and the management of unintentional epinephrine injections.

Introduction A few years ago, the price of an epinephrine auto-injection device increased dramatically. Now with multiple options of epinephrine auto-injectors, we set out to identify what drives patient purchasing trends. Methods Cross sectional study using an anonymous survey. The target population included parents of both male and female children who have purchased an epinephrine auto-injector within the last 10 years. The patient panel included multiple satellite CHKD allergy and immunology clinics. Results We found that while 73% of families we surveyed “completely agreed” to feeling financially burdened by the cost of an epinephrine auto-injector (and 97% overall agreed), 68% “completely agreed” (and 93% overall agreed) to the belief in having a new auto-injector every year. 86% of families “completely agreed” in the importance of having an epinephrine auto-injector at school or daycare and only 15% of families generally worried about the side effects or harm of giving the epinephrine auto-injector. 95% of families generally felt comfortable giving the auto-injector if necessary. The number one factor in deciding which epinephrine auto-injector to purchase was physician recommendation and prescription, followed by price/insurance coverage, then pharmacy suggestion, and finally, ease of use and brand name. Conclusions While a significant majority of our patients feel financially burdened by the cost of epinephrine auto-injectors, they also agree with the importance of purchasing it yearly. Physician recommendation and prescription is the number one deciding factor in their purchasing choice, almost three times more than cost. This study demonstrates the importance of physician awareness of the prices of medications.

Background The prevalence of epinephrine auto-injectors (EAI) use is on the rise. Our objective was to describes children with hooked EAI needles that were embedded in soft tissues. Case presentation Results: Two children self-injected in their shins. The embedded EAIs required removal in the Emergency Department. Both needles were hooked and splayed at the tip. A boy in anaphylaxis kicked his leg during EAI injection and the hooked needle embedded under his skin and was difficult to dislodge. The exposed needle was curved. A girl had an EAI administered for anaphylaxis, which was also difficult to dislodge. On removal, the distal needle tip was hooked approximately 160 degrees. Images of the device revealed that the needle fired off-center from the device and the device components were cracked. We propose three different explanations for these hooked EAI needles. The first is that the needle could hit bone during injection and curve rather than penetrates further. Secondly, the needle could bend when the patient moves during injection. Thirdly, if a needle fires sufficiently off-center to hit the cartridge carrier, this could hook the needle prior to injection. Conclusions Awareness of the reasons for needle hooking, damage observed, and challenges and successful approaches to their removal, can better prepare the provider for these uncommon events. Teaching parents, children and educators about safe EAI storage and appropriate restraint during use may prevent some of these accidental injuries. Reporting device failures may lead to improvements in device performance and design.

Anaphylaxis is a systemic allergic reaction that often involves respiratory symptoms and cardiovascular collapse, which are potentially life-threatening if not treated promptly with intramuscular adrenaline. Owing to the unpredictable nature of anaphylaxis and accidental exposure to allergens (such as peanuts and shellfish), patients should be prescribed intramuscular adrenaline auto-injectors and carry these with them at all times. Patients also need to be able to use their auto-injectors correctly while under high stress, when an anaphylactic attack occurs. Despite this, an alarming number of patients fail to carry their auto-injectors and many patients, carers of children with known anaphylaxis and healthcare professionals do not know how to use the device correctly, despite having had training. Currently available auto-injector devices have various limitations that may impede their use in the management of anaphylaxis. There is also a lack of validated assessment criteria and regulatory requirements for new devices. This review describes the different delivery systems used in currently available auto-injectors and discusses the key barriers to the use of adrenaline auto-injectors, with the goal of identifying the 'ideal' features/characteristics of such devices in the emergency treatment of anaphylaxis that will ensure ease of use, portability and accurate delivery of a life-saving drug.

This study surveyed the prescription patterns of adrenaline auto-injectors (AAs) in Singapore to examine the frequency, triggers, and demographic pattern of anaphylaxis requiring such prescriptions. A 6-year retrospective review of 417 consecutive patients prescribed AAs in Singapore from January 1999 to December 2004, as identified from hospital pharmacy records. There were 417 patients identified, consisting of 295 (70.7%) Singaporeans with the remaining being non-Singaporean residents. Based on population census, the frequency of AA prescriptions was estimated at 1 per 10,000 Singaporeans. Demographic factors associated with AA prescriptions were male gender (OR = 1.361; p = 0.002); minority ethnic groups, which included Eurasians, Caucasians, Koreans, and Japanese (OR = 15.873; p < 0.001); and children

The epinephrine autoinjector (EpiPen, DEY, L.P., Napa, CA) is a lifesaving device, but the teaching of its use has not been properly evaluated. We enrolled parents of pediatric patients (n = 224) with a history of anaphylaxis in a study to evaluate teaching of the use of the EpiPen. Parents were taught nine steps to the correct use of the EpiPen, and were then tested on their knowledge and skills in subsequent visits using a demonstrator. The pass rate was determined for each step on each visit. We found that only 22% (49 of 224) of parents passed all nine tests in the first visit; 68% (152 of 224) passed the tests on the second visit; 94% (211 of 224) passed all of the tests after the third visit; and 6.5% (15 of 224) of parents failed to pass the test even after five visits. The highest failure rates were for the instructions to “press the device until it clicks” and to “press the device steadily for 10 seconds.” Parents who had previously been given an EpiPen demonstrator had a significantly better pas...

Methods Swedish children (0-12 years) and adolescents (13-17 years) with objectively diagnosed food allergy to staple foods were recruited in an outpatient allergy clinic. Ageand sex-matched controls were included. Food-allergic adolescents themselves and the parents of food-allergic children answered a food-allergy specific HRQL questionnaire (FAQLQ), developed within EuroPrevall. A generic HRQL questionnaire, EQ-5D, was answered by parents to cases and controls. In total, 85 children and 58 adolescents (cases), and 94 children and 56 adolescents (controls) participated.

BackgroundAlthough food allergy has universally been found to impair HRQL, studies have found significant differences in HRQL between countries, even when corrected for differences in perceived disease severity. However, little is known about factors other than disease severity which may contribute to HRQL in food-allergic patients. Therefore, the aim of this study was to identify factors which may predict HRQL of food-allergic patients and also to investigate the specific impact of having experienced anaphylaxis and being prescribed an EAI on HRQL.MethodsA total of 648 European food-allergic patients (404 adults, 244 children) completed an age-specific questionnaire package including descriptive questions. Multivariable regression analyses were performed to develop models for predicting HRQL of these patients.ResultsFor adults, the prediction model accounted for 62% of the variance in HRQL and included perceived disease severity, type of symptoms, having a fish or milk allergy, and gender. For children, the prediction model accounted for 28% of the variance in HRQL and included perceived disease severity, having a peanut or soy allergy, and country of origin. For both adults and children, neither experiencing anaphylaxis nor being prescribed an epinephrine auto-injector (EAI) contributed to impairment of HRQL.ConclusionsIn this study, food allergy-related HRQL may be predicted to a greater extent in adults than in children. Allergy to certain foods may cause greater HRQL impairment than others. Country of origin may affect HRQL, at least in children. Experiencing anaphylaxis or being prescribed an EAI has no impact on HRQL in either adults or children.

Article-at-a-Glance Background Epinephrine auto-injectors for food allergy emergency treatment is used as a case study to illustrate how human factors in device design has an impact on proper management of anaphylaxis. Because timely injection is so crucial, epinephrine comes in preloaded syringes or auto-injectors that patients can carry with them. However, many factors influence whether treatment is carried out properly. Human Factors Engineering (HFE) Analysis The incidence of incorrectly using auto-injectors is not isolated; studies have shown that a significant proportion of patients, and even physicians, do not know how to correctly use the devices. Some auto-injectors appear to be modeled with a metaphor in mind (a pen), but they do not appear and operate consistently with the metaphor. In addition, the device is difficult to transport. The portability issue creates a challenge that cannot be adequately addressed with traditional intervention measures—reminders or more education. They are all human factors issues and require human factors-based interventions. Summary Although education and training in how to use an auto-injector are important for effective management of anaphylaxis, a poorly designed device can lead to incorrect operation of such a device. HFE can improve device design so that it is reliably and correctly used even with minimal training. Manufacturers, allergists/immunologists, and pharmacists all have critical roles to play to ensure the correct use of this life-saving device.

L Chad, M Ben-Shoshan, Y Asai. Allergy. 2013;68(12):1605–1609 The purpose of this study was to identify factors that may contribute to parental fear of using an epinephrine autoinjector (EAI). The study included 1229 parents of children with peanut allergy, all of whom had been prescribed an EAI. The mothers had a mean age of 37.9 years, and the fathers had a mean age of 40 years. Children with peanut allergy were retrospectively identified from 2000 to 2004 through chart review, and they were prospectively identified between 2004 and 2011 at their visit …

Currently marketed epinephrine auto-injectors, designed for single-use in an allergic emergency, are prone to unintentional use errors (e.g., holding the device upside down, causing injury to the administrator and, more importantly, no dose for the patient). A simulated use study showed that two alternative designs for a new epinephrine auto-injector, developed using human factors engineering, can reduce such hazards and were significantly preferred by subjects in all age groups tested. Further clinical testing is required before such a pharmaceutical device can be introduced into the market.

Prompt epinephrine administration is crucial in managing anaphylaxis, but epinephrine auto-injectors (EAIs) are underutilized by patients and their families. Children with peanut allergy were recruited from the Allergy Clinics at the Montreal Children's Hospital, food allergy advocacy organizations and organizations providing products to allergic individuals. Parents of children who had been prescribed an EAI were queried on whether they were fearful of using it and on factors that may contribute to fear. A majority of parents (672/1209 = 56%) expressed fear regarding the use of the EAI. Parents attributed the fear to hurting the child, using the EAI incorrectly or a bad outcome. Parents whose child had longer disease duration or a severe reaction and parents who were satisfied with the EAI training or found it easy to use were less likely to be afraid. Families may benefit from simulation training and more education on the recognition and management of anaphylaxis.

Understanding user needs is essential to design biomedical devices that are efficacious in real life (clinically effective). Few studies propose analytic quantitative methods to elicit user needs. This paper presents a preliminary application of the Analytic Hierarchy Process (AHP) to elicit user needs. As a case study we focused on the use of a biomedical device for auto-injection of epinephrine to treat severe allergic reactions. Although the study presented is on-going, the methods we describe provide valuable insights into how quantitative methods can be applied to user needs elicitation.

Susan L Hogue,1 Diana Goss,1 Kelly Hollis,1 Suyapa Silvia,2 Martha V White3 1Health Solutions, RTI International, Research Triangle Park, NC, 2Education and Workforce Development, RTI International, Research Triangle Park, NC, 3Institute for Asthma and Allergy, Wheaton, MD, USA Background: Anaphylaxis is a serious, potentially life-threatening condition. Adequate preparation for anaphylaxis management is imperative for school personnel. This descriptive pilot study assessed preparedness of US schools to manage anaphylactic reactions. Methods: An exploratory, cross-sectional, web-based, pilot survey assessed the occurrence and characteristics of anaphylactic events, as well as training provided to school personnel for the recognition and treatment of anaphylaxis. Eligible US schools were participants in the EpiPen4Schools® program during the 2013–2014 school year. EpiPen4Schools provides EpiPen® (epinephrine injection) Auto-Injectors and training materials to qualifying US schools. Survey data were parsed by US Census Bureau region and state and were evaluated using descriptive statistics. Results: Schools from all 50 states and the District of Columbia participated in the survey (N=6,019). Among schools that provided information on anaphylactic events, 11% (607/5,683) reported the occurrence of one or more events, with significant variability in incidence across census regions and among states. A total of 5,613 schools provided information regarding which staff members were trained to recognize the signs and symptoms of anaphylaxis. Thirty-six percent of schools (2,022/5,613) indicated that only the school nurse and select staff were trained in anaphylaxis recognition. The proportion of schools in which most or all school staff received such training differed by region/state (range, 13%–100%). A total of 5,578 schools provided information on which staff were permitted to administer epinephrine. The majority of schools (54%; 3,024/5,578) permitted only the school nurse and select staff to administer epinephrine, although percentages varied by region/state (range, 4%–100%). Conclusion: Schools differed substantially in their preparedness to manage anaphylaxis, with significant disparities in staff training and permission to treat. Given the ramifications of delayed treatment, removing barriers to the recognition and treatment of anaphylactic events in schools is an important public health goal. Keywords: anaphylaxis, epinephrine, epinephrine auto-injector, preparedness, school nurse, school staff training

A 41-year-old, previously healthy physician, while treating a patient in the emergency department, inadvertently injected the contents of an adult epinephrine (EpiPen® auto-injector into the volar ...

Methods We evaluated mothers of food-allergic children participating in a UK study of epinephrine auto-injectors (EAI), 1 year after they were first trained to use an EAI, either Anapen or Epipen (old design). Participants’ ability to deliver epinephrine using their device was assessed using a simulated anaphylaxis scenario. Participants then underwent repeat assessment using a different EAI device, randomly allocated, without training on the new device. The UK-approved EAIs Epipen (new/old designs), JEXT or Anapen were used, or Intelliject, an EAI with audio/visual prompts approved in North America as AuviQ(tm) and Allerject. ISRCTN29175528

Background Barriers to administering epinephrine auto injectors include failure to recognize signs and symptoms of anaphylaxis, administering oral antihistamines or asthma inhalers due to lack of education, failing to administer epinephrine correctly, fear of giving a needle, auto injector misplaced, and past experiences with spontaneous recovery. The aim of this study is to assess the impact of supervised auto injector administration by parents/patients on confidence, knowledge and skill for future treatment of severe allergic reactions. Methods

Pouessel G, Deschildre A, Castelain C, et al. Pediatr Allergy Immunol. 2006:17:221–226 PURPOSE OF THE STUDY. To assess parental use and knowledge of an epinephrine autoinjector (EAI), Anapen, prescribed for their food-allergic child(ren), and to examine the availability of emergency kits and personalized care plans. STUDY POPULATION. The parents of 152 food-allergic children prescribed an EAI between June 2000 and March 2003 at 1 of 5 children's hospitals in northern France. METHODS. An anonymous-questionnaire format was used to collect details on the child's clinical manifestations of allergies, EAI education by a health care provider, verification of proper EAI use at each follow-up visit, availability of a personalized care plan at school, physician instructions in case of allergic reaction, and medications available at home or outside the home. Parents were also asked to list symptoms that required epinephrine (open-ended item). RESULTS. One hundred nine families representing 111 children completed and returned the survey. The majority (90%) of families had the use of Anapen demonstrated (76% with a trainer device), and 83% had received written instructions. Nineteen percent had a repeat demonstration at follow-up visits, and 10% never received a demonstration; yet, 88% of parents felt that they could use an EAI in an emergency. Only 54% of school-aged children had a personalized care plan, and 11% had an EAI at school with no personalized care plan. Only 48% of the parents could list >1 symptom that required an EAI. There was no difference in the quality of instructions between pediatricians and allergists and no difference in knowledge between parental socioeconomic groups. CONCLUSIONS. EAIs and personal care plans were insufficiently available at schools and in daily life. Proper EAI use and education were unsatisfactory. REVIEWER COMMENTS. This study emphasized the importance of extensive and repeated education about food-allergy risks and measures that need to be in place in case of an emergency. Although a majority of parents felt that they knew how to use an EAI, many could not recognize >1 symptom that would require the use of an EAI, and nearly half of the patients did not have an EAI or emergency plan available at school. A disturbing number (10%) of parents never received EAI education, and for those who received education, only a few (19%) had a review of instructions at follow-up. Repeated EAI education is important, because skills acquired at the initial visit are likely to be lost if they are not practiced, and failure to reiterate the importance of knowing how or when to use an EAI may contribute to parents’ indifferent attitude about carrying an EAI or submitting an appropriate personal care plan to the child's school.