The use of adrenaline autoinjectors by children and teenagers

Noimark, L., Wales, J., Du Toit, G., Pastacaldi, C., Haddad, D., Gardner, J., Hyer, W., Vance, G., Townshend, C., Alfaham, M., Arkwright, P.D., Rao, R., Kapoor, S., Summerfield, A., Warner, J.O. and Roberts, Graham (2012) The use of adrenaline autoinjectors by children and teenagers. Clinical & Experimental Allergy, 42 (2), 284-292. (doi:10.1111/j.1365-2222.2011.03912.x). (PMID:22181034)

Abstract

Background
Although adrenaline is recommended as first line treatment for anaphylaxis, it is often not utilized. There has been a debate about when adrenaline autoinjectors should be prescribed and how many should be dispensed.

Objectives
To see how many adrenaline autoinjectors were used during anaphylactic reactions and to determine why they were not used in situations where they were clinically indicated.

Methods
Patients were recruited prospectively at 14 paediatric allergy clinics throughout UK. Participants completed a questionnaire covering demographic data, atopic status and details of allergic reactions in the previous year and reasons for using more than one device.

Results
A total of 969 patients were recruited of whom 466 (48.1%, 95% CI: 37.9–58.2) had had at least one reaction in the previous year; 245 (25.3%, 95% CI: 16.2–34.4) of these reactions were anaphylaxis. An adrenaline autoinjector was used by 41 (16.7%, 95% CI: 11.7–21.3) participants experiencing anaphylaxis. Thirteen participants received more than one dose of adrenaline, for nine of these a health professional gave at least one. The commonest reasons for using more than one were severe breathing difficulties (40%), lack of improvement with first dose (20%) and miss-firing (13.3%). The commonest reasons for not using adrenaline in anaphylaxis were ‘thought adrenaline unnecessary’ (54.4%) and ‘unsure adrenaline necessary’ (19.1%). Many with wheeze did not use their autoinjector.

Conclusions and Clinical Relevance
Adrenaline is used by only a minority of patients experiencing anaphylaxis in the community. Thirteen of the 41 patients with anaphylaxis who used their autoinjector needed another dose of adrenaline. Further research is needed to consider how to best encourage the usage of adrenaline when clinically indicated in anaphylaxis.

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Contributors

Author: Graham Roberts

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