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The aim of the study was to assess the impact of a video training program (VTP) on primary school teachers' skills in using an adrenaline auto-injector (AAI), in correlation with knowledge regarding allergies, in cases of anaphylaxis. A questionnaire on teachers' knowledge of allergies and on their level of confidence in using an AAI was distributed in primary schools in the French department of Manche (2173 teachers). A VTP followed this questionnaire. A second questionnaire was then distributed. Theoretical knowledge was assessed with a score out of 20. The confidence level was rated on a scale from 1 to 4. We collected 218 responses to the first questionnaire (10.0 % of the population included). The response rate to the second questionnaire was 4.7 % (103 participants), and from this group, 93 of the 103 participants viewed the video (90.3 %). Overall, 76 of the 218 (34.9 %) participants who completed the first questionnaire also completed the second questionnaire and watched the VTP. The number of participants who completed the whole survey was 76 (out of 2173, 3.5 %). The VTP significantly improved teachers' knowledge of the subject of allergies (the average score increased by 2.11 points, p < 0.001) as well as their confidence in recognizing the signs of a severe allergic reaction and in using an AAI: 85.4 % (n = 88) of self-confident teachers after the VTP versus 42.3 % (n = 92) before the VTP (p < 0.001). The VTP improved teachers' level of knowledge and confidence in using an AAI in cases of anaphylaxis. A similar VTP could be circulated more widely in schools to offer easy access to training tools about allergies. [ABSTRACT FROM AUTHOR]

Objective: The internet and social media, which have become a part of daily life, have also become critical sources for obtaining health information. Anyone can upload videos on any topic on Youtube; however, Youtube does not guarantee that the uploaded videos contain the correct information. Failure to use or the misuse of epinephrine auto-injectors (EAIs) can lead to fatal results. The aim of this study was analyze the reliability, understandability, and actionability of the videos on the use of epinephrine auto-injectors published on Youtube. Materials and Methods: The search term 'how to use epinephrine auto-injectors' was searched on YouTube™ (http://www.youtube. com) on 04.10.2022 and the first 200 videos were reviewed. Information about the video was recorded and the Global Quality Scale (GQS), DISCERN (DISCERN is a brief questionnaire that provides users with a valid and reliable way of assessing the quality of written information on treatment choices for a health problem) and Patient Education Materials Assessment Tool (PEMAT) were evaluated. Results: Of the 112 videos, 86.6% of those included in the study were educational for the public. The duration of understandable videos was found to be significantly higher than non-understandable videos (p<0.001). A moderately positive correlation was found between the GQS scores and understandability scores (p<0.001) and between actionability scores (p<0.001). A moderately positive correlation was found between the DISCERN scores and understandability (p<0.001) and actionability scores (p<0.001). The understandability rate of the videos uploaded by physicians and non-physician health workers was found to be significantly lower than the other video uploaders (p<0.01). In the performed linear regression analysis, it was seen that the number of understandable videos published by physicians and non-physician healthcare professionals was significantly lower than the videos uploaded by other users. The number of understandable videos was significantly higher in long videos. Conclusion: There are severe problems regarding the videos' quality, reliability, understandability and actionability. It is thought that Youtube content on the use of EAIs in case of anaphylaxis should be improved. [ABSTRACT FROM AUTHOR]

Introduction: Medical drones have potential for improving the response times to out-of-hospital emergencies. However, widespread adoption is hindered by unanswered questions surrounding medical dispatch and bystander safety. This study evaluated the impact of novel drone-specific dispatch instructions (DSDI) on bystanders’ ability to interact effectively with a medical drone and provide prompt, safe, and high-quality treatment in a simulated emergency scenario.11 Drone-specific dispatch instructions. We hypothesized DSDI would improve bystanders’ performance and facilitate safer bystander-drone interactions. Methods: Twenty-four volunteers were randomized to receive either DSDI and standard Medical Priority Dispatch (MPD) instructions or MPD alone in a simulated out-of-hospital cardiac arrest (OHCA) or pediatric anaphylaxis.,22 Medical priority dispatch3 Out-of-hospital cardiac arrest.3 Participants in the DSDI group received detailed instructions on locating and interacting with the drone and its enclosed medical kit. The simulations were video recorded. Participants completed a semi-structured interview and survey. Results: The addition of DSDI did not lead to statistically significant changes to the overall time to provide care in either the anaphylaxis or OHCA simulations. However, DSDI did have an impact on bystander safety. In the MPD only group, 50% (6/12) of participants ignored the audio and visual safety cues from the drone instead of waiting for it to be declared safe compared to no DSDI participants ignoring these safety cues. Conclusions: All participants successfully provided patient care. However, this study indicates that DSDI may be useful to ensure bystander safety and should be incorporated in the continued development of emergency medical drones.

Case Presentation: A four-year-old female patient presented to the emergency department with an epinephrine auto-injector that had unintentionally discharged into her mandible. There was difficulty removing the auto-injector at bedside. Images we acquired noted needle curvature not present in an off-the-shelf model. She was sedated, and the auto-injector was removed by retracing the angle of discharge, with care taken not to inject epinephrine into the patient.Discussion: Epinephrine auto-injector accidental discharges are an unusual injury pattern, but the incidence of such events is increasing in the United States. The emergency clinician should be cognizant of complicating factors with discharges, such as bent needles. Here we discuss a case of discharge into the maxillofacial region (lower jaw), with approaches to treatment.

OBJECTIVE: Anaphylaxis is a severe hypersensitivity reaction with a rapid onset and is potentially life-threatening if not treated promptly. This study aimed to determine the level of knowledge of pediatricians in Turkey in recognizing and treating the clinical symptoms of anaphylaxis, compare the previous studies conducted in Turkey chronologically, and show the current trends on awareness of anaphylaxis in developed and developing countries in the world. SUBJECTS AND METHODS: Pediatric residents and specialists from all over Turkey were included in the study. A questionnaire was prepared by compiling the current literature. Questions were sent to pediatricians via online applications. Statistical tests were used to analyze the data. RESULTS: A total of 524 pediatricians participated in the study. All participants accepted that anaphylaxis was a life-threatening condition. Al-most all suggested epinephrine as the primary drug used in anaphylaxis. The proportion of pediatricians who knew the appropriate dose, route of administration, and place of administration of epinephrine was 82.8%, 88.9%, and 89.7%, respectively. The rate of pediatricians who recognized the clinical features of anaphylaxis was over 90%. The proportion of pediatricians who knew the epinephrine auto-injector and dose was 74.4% and 53.1%, respectively. Pediatricians with less than 10 years of experience and those working in public hospitals had better knowledge about atypical symptoms of anaphylaxis. CONCLUSIONS: Although there are still inadequacies in identifying atypical symptoms and treating anaphylaxis, our study revealed that the level of awareness of anaphylaxis had shown an increasing trend in Turkey over time. On the other hand, the knowledge on diagnosing and treating anaphylaxis still needs to be improved, especially for physicians working in rural areas of developing countries. [ABSTRACT FROM AUTHOR]

Background: Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions and can cause death. Given the prevalence of anaphylaxis within healthcare systems, it is a high priority public health issue. However, management of anaphylaxis – both acute and preventative – varies by region. Methods: The World Allergy Organization (WAO) Anaphylaxis Committee and the WAO Junior Members Steering Group undertook a global online survey to evaluate local practice in the diagnosis and management of anaphylaxis across regions. Results: Responses were received from WAO members in 66 countries. While intramuscular epinephrine (adrenaline) is first-line treatment for anaphylaxis, some countries continue to recommend alternative routes in contrast to guidelines. Epinephrine auto-injector (EAI) devices, prescribed to individuals at ongoing risk of anaphylaxis in the community setting, are only available in 60% of countries surveyed, mainly in high-income countries. Many countries in South America, Africa/Middle-East and Asian-Pacific regions do not have EAI available, or depend on individual importation. In countries where EAIs are commercially available, national policies regarding the availability of EAIs in public settings are limited to few countries (16%). There is no consensus regarding the time patients should be observed following emergency treatment of anaphylaxis. Conclusion: This survey provides a global snapshot view of the current management of anaphylaxis, and highlights key unmet needs including the global availability of epinephrine for self-injection as a key component of anaphylaxis management.

Introduction: Food-induced anaphylaxis among infants shows an increasing prevalence; however, the prescription of epinephrine auto-injectors (EAIs) for children weighing <15 kg is associated with issues of the needle length and the epinephrine dose. Several studies have shown age-related differences in food-induced anaphylaxis, although little is known about the weight-related differences in food-induced anaphylaxis. This study aimed to reveal the incidence, clinical characteristics, and management of food-induced anaphylaxis in children weighing <15 kg. Methods: This chart review included children who visited the pediatric emergency department (ED) of the National Center for Child Health and Development (Tokyo, Japan) from January 2014 to December 2016 and were diagnosed with food-induced anaphylaxis. The severity of anaphylaxis was evaluated using the Sampson Grading Scale. Results: Of 89,232 ED visits, 444 visits included patients with food-induced anaphylaxis, after excluding cases of food-induced anaphylaxis related to oral desensitization therapy. The incidence was 4.98 per 1,000 visits. More than half of the children (n = 247/444, 55.6%) weighed <15 kg. The proportion of grade 3 and higher severity anaphylactic symptoms was 74.5% (184/247) in children weighing <15 kg and 79.2% (156/197) in children weighing 15 kg or more. The recurrence rate of food-induced anaphylaxis was 22.3% (55/247) in children weighing <15 kg and 48.7% (96/197) in children weighing 15 kg or more. Among the children weighing <15 kg, the proportion of those with recurrent food-induced anaphylaxis was 4 times higher in children weighing 10–15 kg than in those weighing <10 kg (32.2% [47/146] vs. 7.9% [8/101]). The proportion of patients who were prescribed EAIs before each visit was 25.5% (14/55) in children weighing <15 kg with a history of food-induced anaphylaxis. Conclusion: Food-induced anaphylaxis among children weighing <15 kg occurred as frequently and was as severe as that among children weighing 15 kg or more. However, the proportion of patients prescribed EAIs was very low in children weighing <15 kg with food-induced anaphylaxis. The potential need for EAIs is suggested among children weighing <15 kg, especially among children weighing 10 kg or more but <15 kg. [ABSTRACT FROM AUTHOR]

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

Anaphylaxis is a severe allergic reaction that can lead to death if not treated quickly. Adrenaline (epinephrine) is the first‐line treatment for anaphylaxis and its prompt administration is vital to reduce mortality. Following a number of high‐profile cases, serious concerns have been raised, both about the optimal dose of intramuscular adrenaline via an auto‐injector and the correct needle length to ensure maximal penetration every time. To date, the public data are sparse on the pharmacokinetics–pharmacodynamics of adrenaline administered via an auto‐injector. The limited available literature showed a huge variation in the plasma concentrations of adrenaline administered through an auto‐injector, as well as variations in the auto‐injector needle length. Hence, delivering an effective dose during an anaphylaxis remains a challenge for both patients and healthcare professionals. Collaborative work between pharmacokinetics–pharmacodynamics experts, clinical triallists and licence holders is imperative to address this gap in evidence so that we can improve outcomes of anaphylaxis. In addition, we advise inclusion of expertise of human factors in usability studies given the necessity of carer or self‐administration in the uniquely stressful nature of anaphylaxis. [ABSTRACT FROM AUTHOR]

Introduction: Medical drones have potential for improving the response times to out-of-hospital emergencies. However, widespread adoption is hindered by unanswered questions surrounding medical dispatch and bystander safety. This study evaluated the impact of novel drone-specific dispatch instructions (DSDI) on bystanders' ability to interact effectively with a medical drone and provide prompt, safe, and high-quality treatment in a simulated emergency scenario. We hypothesized DSDI would improve bystanders' performance and facilitate safer bystander-drone interactions., Methods: Twenty-four volunteers were randomized to receive either DSDI and standard Medical Priority Dispatch (MPD) instructions or MPD alone in a simulated out-of-hospital cardiac arrest (OHCA) or pediatric anaphylaxis., 3 Participants in the DSDI group received detailed instructions on locating and interacting with the drone and its enclosed medical kit. The simulations were video recorded. Participants completed a semi-structured interview and survey., Results: The addition of DSDI did not lead to statistically significant changes to the overall time to provide care in either the anaphylaxis or OHCA simulations. However, DSDI did have an impact on bystander safety. In the MPD only group, 50% (6/12) of participants ignored the audio and visual safety cues from the drone instead of waiting for it to be declared safe compared to no DSDI participants ignoring these safety cues., Conclusions: All participants successfully provided patient care. However, this study indicates that DSDI may be useful to ensure bystander safety and should be incorporated in the continued development of emergency medical drones., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Christine M. Brent reports financial support was provided by Toyota Motor Corporation. James M. Pribble reports financial support was provided by Toyota Motor Corporation. Laura R. Hopson reports financial support was provided by Toyota Motor Corporation. Emily J. Mathias reports financial support was provided by Toyota Motor Corporation. Nathaniel Hunt reports financial support was provided by Toyota Motor Corporation. Christine M. Brent reports a relationship with the Medical Control Authority of Michigan that includes: board membership. Co-author employed by Emergent Health Partners − E.E.D. Co-author employed by Emergent Health Partners − I.G.S. Co-author employed by Emergent Health Partners − N.K.M. Corresponding author employed as EMS Medical Director − C.M.B. Co-author employed as EMS Medical Director − N.H. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Abstract Background Skin-to-bone distance (STBD) in children prescribed a pediatric epinephrine auto-injector (EAI) for anaphylaxis is not commonly measured in practice. Recent evidence suggests that children with STBD less than the exposed needle length of available pediatric EAIs (dose: 0.15 mg, needle length: 12.7 mm) are at risk for unintentional injections to the bone during their use for an allergic emergency. Case presentation Described here is a case of a female child with multiple food allergies prescribed a pediatric EAI (0.15 mg EpiPen Jr®) who experienced an unintentional injection to her femur. The patient’s STBD at the recommended injection site (vastus lateralis) was shorter than the needle length of her prescribed EAI (12.7 mm) at the time of the injury (age: 7, height: 122 cm; weight: 25 kg), even though her weight was within the indication for this EAI (15–30 kg). The patient and her family were made aware of the risk of unintentional bone injection at the time the EAI was prescribed. Conclusions Some children, even those at an appropriate weight per the indication of available pediatric EAIs (0.15 mg), may be at risk for unintentional injections to the bone. The effects of an unintentional bone injection with an EAI can have lasting effects on a child, including pain. Healthcare providers who prescribe pediatric EAIs for any child should consider evaluating this risk, inform patients and parents of the risk, and take measures to potentially mitigate unintentional bone injections. For some children, an EAI with a shorter needle length may be a more appropriate choice of treatment for anaphylaxis.

Objective: Food allergies are on the rise in the U.S. Factors associated with willingness and readiness to act in a food allergic emergency on a college campus are currently unknown. Participants: College students in one Catholic college enrolled during spring of 2017. Methods: A previously piloted survey was distributed by e-mail. Results: Four hundred seventy-four individuals responded. All readiness components correlated, and all willingness components correlated with each other. Age, having children, college major had statistically significant correlations with readiness and willingness to act. Readiness was highly predictive of willingness to act in an FAE. Thirty-five percent of variability in willingness to act was explained by age, being health professions students, desire to be trained, social desirability, and readiness. Students in nonhealth related majors expressed high willingness, but low readiness. Conclusion: A pool of willing, trained to act individuals should be considered on college campuses including availability of unassigned epinephrine auto-injector. [ABSTRACT FROM AUTHOR]

Adil Adatia,1 Ann Elaine Clarke,2 Yarden Yanishevsky,3 Moshe Ben-Shoshan4 1Department of Medicine, University of Alberta, Edmonton, 2Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, 3Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Alberta, Edmonton, AB, 4Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada Abstract: Sesame is an important global allergen affecting ~0.1% of the North American population. It is a major cause of anaphylaxis in the Middle East and is the third most common food allergen in Israel. We conducted a systematic review of original articles published in the last 10 years regarding the diagnosis and management of sesame allergy. Skin prick testing appears to be a useful predictor of sesame allergy in infants, although data are less consistent in older children and adults. The diagnostic capacity of serum-specific immunoglobulin E is poor, especially in studies that used oral food challenges to confirm the diagnosis. Double-blind, placebo-controlled food challenge thus remains the diagnostic gold standard for sesame allergy. The cornerstone of sesame allergy management is allergen avoidance, though accidental exposures are common and patients must be prepared to treat the consequent reactions with epinephrine. Novel diagnostic and treatment options such as component-resolved diagnostics, basophil activation testing, and oral immunotherapy are under development but are not ready for mainstream clinical application. Keywords: sesame allergy, skin prick testing, specific IgE, component-resolved diagnostics, epinephrine autoinjector

Les réactions anaphylactiques connaissent une augmentation inquiétante, notamment chez l'enfant. L'anaphylaxie est une réaction allergique brutale, sévère, potentiellement létale, pouvant toucher les systèmes cutanéomuqueux, gastro-intestinal, respiratoire et cardiovasculaire. Des critères diagnostiques précis ont été définis. Bien que les symptômes d'une anaphylaxie soient variables en fonction de l'âge de l'enfant et de l'allergène déclencheur, ces critères diagnostiques sont fiables chez le nourrisson, l'enfant et l'adolescent. Les allergènes responsables les plus fréquents sont les aliments, suivis du venin d'insectes puis des médicaments. Le traitement de première intention est l'adrénaline. Elle doit être injectée par voie intramusculaire le plus tôt possible. Même en cas d'évolution favorable, une surveillance prolongée de 24 h est recommandée en raison de l'existence de réactions biphasiques retardées. En cas d'évolution défavorable, l'administration d'adrénaline doit être renouvelée. À distance de l'anaphylaxie l'enquête et le suivi allergologiques sont indispensables. Ils guident la mise en place des mesures préventives et thérapeutiques, notamment la prescription d'adrénaline auto-injectable et/ou d'un plan d'accueil individualisé. The prevalence of anaphylaxis has increased for two decades, especially among children. Anaphylaxis is an acute severe reaction involving the skin, gastrointestinal and respiratory tracts, and cardiovascular system. Clinical criteria for diagnosing anaphylaxis were defined to help physician. Even if the clinical manifestations of anaphylaxis depend on age and allergen, the diagnostic criteria are reliable in infants, children and teenagers. The first-line treatment is epinephrine, regardless of age. It must be injected intramuscularly as soon as possible. Because biphasic reactions can occur after initial resolution, a advisable length of time for observation of an anaphylactic patient is 24 h. Some patients with persistent symptoms may require repeat doses of epinephrine. The mainstays of long-term management include specialist assessment, avoidance measures, the provision of an epinephrine auto-injector and an individualized anaphylaxis action plan. [ABSTRACT FROM AUTHOR]

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

Background: Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions and can cause death. Given the prevalence of anaphylaxis within healthcare systems, it is a high priority public health issue. However, management of anaphylaxis - both acute and preventative - varies by region., Methods: The World Allergy Organization (WAO) Anaphylaxis Committee and the WAO Junior Members Steering Group undertook a global online survey to evaluate local practice in the diagnosis and management of anaphylaxis across regions., Results: Responses were received from WAO members in 66 countries. While intramuscular epinephrine (adrenaline) is first-line treatment for anaphylaxis, some countries continue to recommend alternative routes in contrast to guidelines. Epinephrine auto-injector (EAI) devices, prescribed to individuals at ongoing risk of anaphylaxis in the community setting, are only available in 60% of countries surveyed , mainly in high-income countries. Many countries in South America, Africa/Middle-East and Asian-Pacific regions do not have EAI available, or depend on individual importation. In countries where EAIs are commercially available, national policies regarding the availability of EAIs in public settings are limited to few countries (16%). There is no consensus regarding the time patients should be observed following emergency treatment of anaphylaxis., Conclusion: This survey provides a global snapshot view of the current management of anaphylaxis, and highlights key unmet needs including the global availability of epinephrine for self-injection as a key component of anaphylaxis management., Competing Interests: The authors declare that they do not have any conflict of interests related to the contents of this article., (© 2023 The Author(s).)

ABSTRACT: BACKGROUND: Anaphylaxis is a serious and growing concern in the school setting as the prevalence of food allergies and food‐induced severe allergic reactions continues to increase. METHODS: A cross‐sectional, web‐based survey was conducted regarding anaphylactic events that occurred during the 2014‐2015 school year. Eligible schools were enrolled in the EPIPEN4SCHOOLS® program (Mylan Specialty L.P., Canonsburg, PA), which provides free epinephrine auto‐injectors to qualifying US schools. Participating schools completed a 29‐item survey on anaphylactic event occurrence and treatment, epinephrine stock, school policies regarding anaphylaxis, school staff training, and school nursing coverage. RESULTS: Responses were provided by 12,275 schools. Epinephrine was administered on school property for 63.7% of reported anaphylactic events (1272/1998). In 38.5% (235/610) of events for which epinephrine was not used, antihistamines were cited as the reason. Only 59.4% of schools cited epinephrine as their standard first‐line therapy for anaphylaxis. School nurses were most likely to be trained in anaphylaxis recognition and permitted to administer epinephrine; however, just 53.6% of schools had a full‐time nurse on staff. CONCLUSIONS: Process‐related barriers to the appropriate use of epinephrine go beyond access to medication. Widespread staff training and review of school policies are needed to ensure that anaphylaxis is appropriately managed in schools. [ABSTRACT FROM AUTHOR]

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 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Food-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. Methods Dutch 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. Results Food-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. Conclusions The 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. [ABSTRACT FROM AUTHOR]

Background Food allergy ( FA) is one of the most important health issues in schoolchildren. Although one of the most common places where pediatric anaphylaxis occurs is the home of a peer, the perception and experiences of caregivers who do not have a child with FA are unclear. Methods An anonymous paper-based questionnaire was distributed to caregivers of FA children ( FA caregivers) in the National Center for Child Health and Development and caregivers of non- FA children (non- FA caregivers) in public school in Tokyo. We examined the perception and experiences of FA among three groups: Group 1, non- FA caregiver who had not witnessed adverse reactions and near-miss events related to FA; Group 2, non- FA caregivers who had witnessed adverse reactions and near-miss events related to FA; and Group 3, caregivers who had a child with FA. Results Epinephrine auto-injector was recognized by 43.6% non- FA caregivers. Only 2.8% of non- FA caregivers had experienced a child being bullied, harassed, or refused by a school because of FA. There were more caregivers in Group 2 who thought they could take the appropriate action if they witnessed a child with adverse response to causal food than in Group 1 (p < 0.05). All groups felt anxious over adverse events related to FA. Conclusion The experiences and perception of FA were lacking among non- FA caregivers. Therefore, it is also important to provide FA education for non- FA caregivers to improve the quality of life of FA children. [ABSTRACT FROM AUTHOR]

Background: The knowledge of general practitioner(s) (GPs) regarding food allergy and anaphylaxis and practices in the prescription of epinephrine auto-injector(s) (EAIs) among GPs has previously only been studied using questionnaires and hypothetical cases. Therefore, there are currently no data as to whether or not GPs prescribe EAIs to high risk food-allergic patients presenting to primary care practices. The aim of this study was therefore to describe and evaluate practice in EAI prescription by GPs to food-allergic patients in The Netherlands. Methods: Patients aged 12-23 years who consulted their GP for allergic symptoms were identified in a primary care database. Patients were classified as probably or unlikely to be food-allergic. A risk factor assessment was done to identify probably food-allergic patients at high risk for anaphylaxis to assess the need for an EAI. Results: One hundred forty-eight out of 1015 patients consulted their GP for allergic symptoms due to food. Eighty patients were excluded from analysis because of incomplete records. Thirty-four patients were classified as probably food-allergic. Twenty-seven of them were considered high risk patients and candidates for an EAI. Importantly, only 10 of them had actually been prescribed an EAI by their GP. Conclusions: This study shows that high risk food-allergic patients that visit their GPs are often not prescribed an EAI. Thus, previously identified low rates of EAI ownership may be partly due to GPs not prescribing this medication to patients for whom it would be appropriate to do so. These data suggest that there is a need for improvement of the quality of care for high risk food-allergic patients in primary care. [ABSTRACT FROM AUTHOR]

Aim: Only epinephrine should be administered to treat anaphylaxis and patients should be prescribed epinephrine auto-injectors on discharge. This questionnaire study was designed to determine the awareness of physicians and other healthcare providers concerning anaphylaxis and the use of epinephrine auto-injectors at a tertiary child care hospital. Materials and Methods: The study was carried out between February 1st and March 15th, 2014 at Dr. Sami Ulus Maternity and Children's Research and Training Hospital, a tertiary care hospital. A total of 166 healthcare providers, including physicians and other staff such as nurses and paramedics, participated in the study. The demographic characteristics, experience in treating anaphylaxis and epinephrine auto-injector training were obtained using a standardized questionnaire. The obtained data were statistically analyzed. Results: The participants were composed of specialist doctors (25.9%), pediatric residents (31.9%) and other healthcare staff (42.2%). Eighty-four (50.6%) of the participants were found to have received training on anaphylaxis. Among the trained healthcare providers, 62 (73.8%) informed us that epinephrine by intramuscular route was applied during anaphylaxis. On the other hand, only 32 (39%) of untrained healthcare providers had chosen the intramuscular administration of epinephrine (p=0.00). 27.8% of those who had not received anaphylaxis training knew about it, while 64.8% of the healthcare providers who had received anaphylaxis training knew about adrenaline autoinjector. Only 5 of those who knew about the adrenaline auto-injector (5.3%) had prescribed the adrenaline report. While 81 (48.8%) of the participitants had some knowledge about the epinephrine auto-injector, only two specialists and three pediatric residents (3%) were found to prescribe the epinephrine auto-injector. Conclusion: Post-graduate training is required for the treatment of anaphylaxis. All healthcare providers should be trained on the use of epinephrine and prescribing epinephrine auto-injector. [ABSTRACT FROM AUTHOR]

Background Although 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. Methods A 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. Results For 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. Conclusions In 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. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Studies show that intramuscular epinephrine results in peak plasma concentrations of epinephrine faster than the subcutaneous route, and therefore, epinephrine is recommended to be administered intramuscularly. The objective of this study was to determine if the needle length on epinephrine auto-injectors is adequate to deliver epinephrine intramuscularly in children. METHODS: Patients between the ages of 1 and 12 years who presented to a children's hospital were enrolled in the study. Ultrasound was used to determine the depth from the skin to the vastus lateralis muscle. The patient's body mass index was recorded. The data were analyzed using simple descriptive statistics, and logistic regression was used to identify variables that might predict whether or not the needle length was exceeded. RESULTS: A total of 256 children were enrolled. Of these, 158 children weighed less than 30 kilograms and would be prescribed the 0.15mg epinephrine auto-injector. Nineteen of these children (12%) had a skin to muscle surface distance of >½″ and would not receive epinephrine intramuscularly from current auto-injectors. There were 98 children weighing ⩾30 kilograms who would receive the 0.3 mg epinephrine auto-injector. Of these 98 children, a total of 29 (30%) had a skin to muscle surface distance of >⅝″ and would not receive epinephrine intramuscularly. CONCLUSION: The needle on epinephrine auto-injectors is not long enough to reach the muscle in a significant number of children. Increasing the needle length on the auto-injectors would increase the likelihood that more children receive epinephrine by the recommended intramuscular route. [ABSTRACT FROM AUTHOR]