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Freerk Prenzel,1,2 Karl Nissler,3 Manuela Siekmeyer,1 Maike vom Hove,1,2 Gudrun Schleicher,4 Wieland Kiess,1 Tobias Lipek1,2 1Department of Pediatrics, University of Leipzig Medical Center, Leipzig, Germany; 2Leipzig Interdisciplinary Center for Allergy (LICA), Leipzig, Germany; 3Department of Pediatrics, Sana Hospitals Leipzig Region, Borna, Germany; 4Pediatric Medical Practice, Rötha, GermanyCorrespondence: Freerk PrenzelDepartment of Pediatrics, University of Leipzig Medical Center, Liebigstr. 20a, Leipzig 04179, GermanyTel +49 341 9726241Fax +49 341 9724119Email freerk.prenzel@uniklinik-leipzig.deAbstract: On our pediatric intensive care unit, we successfully treated a 10-year-old boy with severe pulmonary edema due to anaphylaxis after his last injection of a 3-year course of allergen immunotherapy (AIT). In view of the severity of the adverse event, we initiated a case analysis with all involved medical professionals. The evaluation revealed delayed administration of epinephrine due to dosing uncertainty and underestimation of severity. Consequently, all involved institutions established epinephrine auto-injectors (EAIs) in their emergency equipment. We suggest providing EAIs in every practice conducting AIT, as well as in pediatric emergency rooms and ambulances. We would like to remind readers of the risk of anaphylaxis, even on the last day of AIT.Keywords: epinephrine auto-injector, allergen immunotherapy, emergency equipment, house dust mite

Dirk Schnabel,1 Carl-Joachim Partsch,2 Muriel Houang,3 Sarah Ehtisham,4 Helen Johnstone,5 Markus Zabransky,6 Wieland Kiess7 1Pediatric Endocrinology, Center for Chronic Sick Children, Otto-Heubner-Centrum für Kinder- und Jugendmedizin, Charite, University Medicine, Berlin, Germany; 2Endokrinologikum Hamburg, Hamburg, Germany; 3Explorations Fonctionnelles Endocriniennes, Hôpital Armand Trousseau, Paris, France; 4Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates; 5The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; 6Sandoz International GmbH, Holzkirchen, 7Department of Women and Child Health, Hospital for Children and Adolescents, University Hospitals, University of Leipzig, Leipzig, Germany Background: A questionnaire-based survey was conducted to assess attitudes toward a reusable self-injection system (SurePal™) among pediatric patients with growth disturbances who were prescribed treatment with Omnitrope® within routine clinical practice.Methods: This was a multicenter, observational study, incorporated into the noninterventional PAtients TReated with Omnitrope® (PATRO) Children study. Included subjects, or their caregivers, completed a questionnaire on the following five main areas: attractiveness of SurePal™, training received, using the device, the low drug wastage system, and experience versus other devices used previously (pretreated patients). Responses were based on a 5-point scale, with 2 being the best possible outcome and −2 the worst possible outcome.Results: In total, 550 patients were included in this study (338 from France, 169 from Germany, and 43 from the UK). The mean age ± standard deviation of participants was 10.8±3.5 years; the majority (57%) were male and growth hormone treatment naïve (88%). Almost half (49.8%) of children prepared their SurePal™ for injection themselves and 45.5% performed injections themselves. As patients progressed into their teens, the majority (≥75%) favored preparing SurePal™ and performing injections themselves, rather than seeking assistance. The attractiveness of SurePal™ was rated as excellent/good by 84.7% of patients overall; this rating was similarly high (≥79%) across countries and age-groups. Preparing (88.8%) and using (83.3%) SurePal™ were rated as very easy/easy by most patients; these ratings were similarly high, irrespective of country or age-group. The dose-memory function was rated as very helpful/helpful by 66.2% of patients. Among 246 patients who reported using the low drug-waste feature, 87.4% found it helpful. Among pretreated patients (n=64), 78.2% reported that SurePal™ was much better/better than their previous device.Conclusion: These data confirm the ease of use and patient preference for SurePal™ among pediatric patients with growth disturbances. Keywords: PATRO children, Omnitrope®, SurePal™, self-injection, growth hormone, intervention adherence

Carl-Joachim Partsch,1 Dirk Schnabel,2 Sarah Ehtisham,3 Helen C Johnstone,4 Markus Zabransky,5 Wieland Kiess61Endokrinologikum Hamburg, Hamburg, 2Division of Endocrinology and Diabetology, Otto-Heubner-Center for Pediatric and Adolescent Medicine, Charité University, Berlin, Germany; 3Central Manchester University Hospitals NHS Foundation Trust, Manchester, 4The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; 5Sandoz International GmbH, Holzkirchen, 6Department of Women and Child Health, Hospital for Children and Adolescents, University Hospitals, University of Leipzig, Leipzig, GermanyBackground: SurePal™ is a reusable self-injection system that has been developed to support daily administration of Omnitrope® (Sandoz, Kundl, Austria). A questionnaire-based cross-sectional survey was conducted to evaluate acceptability of, and preference for, SurePal™ in pediatric patients who were prescribed treatment with Omnitrope® within routine clinical care.Methods: This multicenter, observational study was incorporated into the ongoing non-interventional PATRO (PAtients TReated with Omnitrope®) Children study. Patients (or caregivers) were provided with a questionnaire that included five main topics; attractiveness of the device, training received, using SurePal™, the low drug wastage system, and experience versus other devices used previously (where applicable). Questions were scored on a 5-point scale, with -2 being the worst possible outcome (eg, very hard/very poor) and 2 being the best possible outcome (eg, very easy/excellent).Results: A total of 186 patients were included in this study (Germany, n=154; UK, n=32). The attractiveness of SurePal™ was rated as excellent/good by 87.1% of patients. Overall, 86.5% of patients found that using their SurePal™ was very easy/easy. Almost all patients (96.2%) found that preparing their SurePal™ for injection was very easy/easy, and 89.2% found that injecting with SurePal™ was very easy/easy. 85.5% of patients recorded that the dose memory function was helpful, and 87.6% that taking their SurePal™ apart after an injection was very easy/easy. Of the 88 patients who recorded that they had used the low drug waste feature, 89.8% found the feature to be helpful. Among pre-treated patients (n=42), 81% recorded that SurePal™ was much better/better than their previously used device.Conclusion: This questionnaire-based cross-sectional survey in pediatric patients confirms the ease of use and patient preference for SurePal™, a reusable self-injection system that has been developed to support daily administration of Omnitrope®.Keywords: PATRO children, Omnitrope, SurePal, self-injection, growth hormone, intervention adherence