El pediatra de Atención Primaria y la anafilaxia / The primary care pediatrician and anaphylaxis

La anafilaxia es una reacción alérgica grave de instauración rápida y potencialmente mortal. El diagnóstico de anafilaxia es clínico y debe realizarse de manera precoz. Aparece en las 2 primeras horas tras exposición al alérgeno, en los primeros 30 minutos en alergia alimentaria y más precozmente con medicamentos intravenosos o picaduras de himenópteros. Los síntomas cutáneos suelen ser los primeros en manifestarse y están presentes en la mayoría de los casos, más de un 80%. Pueden ser leves o transitorios e incluso no estar presentes en un 18% de los casos. Si se afecta el sistema cardiocirculatorio estaríamos ante un shock anafiláctico. La causa más frecuente en Pediatría son los alimentos. Existen cofactores cuya presencia aumenta la probabilidad de anafilaxia; los más importantes son: el ejercicio, los fármacos, la fiebre y el estrés. El tratamiento de elección es la adrenalina intramuscular. Tanto los padres como los niños deben saber identificar los signos y/o síntomas del inicio de la anafilaxia para instaurar el tratamiento pautado en el plan de acción escrito.

Anaphylaxis is a severe, rapid and potentially fatal allergic reaction. The diagnosis of anaphylaxis is clinical and must be early. It appears in the first 2 hours after exposure to the allergen, in the first 30 minutes in food allergy and earlier with intravenous drugs or hymenoptera stings. Cutaneous symptoms are generally the first to appear and are present in most cases, more than 80%. They may be mild or transitory, or absent in 18% of cases. If the cardio-circulatory system is affected, an anaphylactic shock occurs. The most frequent cause in pediatrics is nutrition. There are several cofactors whose presence increases the likelihood of anaphylaxis; the most important are: exercise, medication, fever and stress. The treatment of choice is intramuscular adrenaline. Parents and children should be able to identify the signs and/or symptoms of anaphylaxis in order to implement the treatment prescribed in the written action plan. (AU)

Efecto de las metodologías analíticas en la cuantificación de bitartrato de epinefrina según la USP-43 y USP-44 / Effect of analytical methodologies on the quantification of epinephrine bitartrate according to USP-43 and USP-44

Introducción: El bitartrato de epinefrina, también conocido como epinefrina, es un ingrediente farmacéutico importante en el tratamiento de diversas enfermedades, pero su medición precisa es esencial para garantizar la seguridad del medicamento. La Farmacopea de los Estados Unidos (USP) establece los estándares para su análisis, pero la elección del método afecta la precisión de las mediciones. Este estudio investiga cómo los diferentes métodos afectan la medición del bitartrato de epinefrina según las versiones USP-43 y USP-44, que tienen implicaciones significativas para la calidad y la regulación de los medicamentos en el campo. Método: Se eligieron el método volumétrico y el método cromatográfico para comparación. Se utilizaron muestras de epinefrina bitartrato de alta pureza que cumplían con los estándares de la USP-43 y USP-44.Resultados: Los resultados obtenidos por ambos métodos se comparan entre sí y se evalúan según los límites de especificación definidos por USP-43 y USP-44. Los valores obtenidos para algunos parámetros, como la concentración y la pureza del bitartrato de epinefrina, varían considerablemente entre los distintos métodos analíticos. Conclusiones: Este estudio destaca la importancia de una cuidadosa selección del método analítico al evaluar el bitartrato de epinefrina según las directrices USP-43 y USP-44. La elección de la tecnología afecta a los resultados y, por tanto, a la calidad y seguridad de los productos farmacéuticos que contienen esta sustancia. Se recomienda validar el método en cada laboratorio y comparar los resultados con los estándares USP. (AU)

Introduction: Epinephrine bitartrate, also known as epinephrine, is an important pharmaceutical ingredient in the treatment of various diseases, but its accurate measurement is essential to ensure the safety of the drug. The United States Pharmacopeia (USP) sets the standards for its analysis, but the choice of method affects the precision of the measurements. This study investigates how different methods affect the measurements of epinephrine bitartrate based on USP-43 and USP-44, which have significant implications for drug quality and regulation in the field. Method: The volumetric method and chromatographic method were chosen for comparison. High-purity epineph-rine bitartrate samples that met USP-43 and USP-44 standards were used. Results: The results obtained by both methods are compared with and evaluated according to the specification lim-its defined by USP-43 and USP-44. The values obtained for some parameters, such as the concentration and purity of epinephrine tartrate, vary considerably between the different analytical methods. Conclusions: This study highlights the importance of carefully selecting analytical methods when evaluating epi-nephrine tartrate according to USP-43 and USP-44 guidelines. The choice of technology affects the results and, therefore, the quality and safety of the pharmaceutical products containing this substance. It is recommended to validate the method in each laboratory and compare the results with USP standards. (AU)

High throughput virtual screening strategy to develop a potential treatment for bronchial asthma by targeting interleukin 13 cytokine signaling

Chronic inflammation in the airway passage leads to the clinical syndrome of pediatric asthma. Allergic reactions caused by bacterial, viral, and fungal infection lead to the immune dis-balance which primes T helper cells (Th2), a specific cluster of differentiation 4 (CD4) T cell differentiation. This favors the Th2-specific response by activating the inter-leukin 4/interleukin 13 (IL-4/IL-13) cytokine signaling and further activates the secretion of immunoglobulin E (IgE). IL-13 develops bronchial asthma by elevating bronchial hyperresponsiveness and enables production of immunoglobulin M (IgM) and IgE. The present study aims to target IL-13 signaling using molecular docking and understanding molecular dynamic simulation (MDS) to propose a compelling candidate to treat asthma. We developed a library of available allergic drugs (n=20) and checked the binding affinity against IL-13 protein (3BPN.pdb) through molecular docking and confirmed the best pose binding energy of –3.84 and –3.71 for epinephrine and guaifenesin, respectively. Studying the interaction of hydrogen bonds and Van der Walls, it is estimated that electrostatic energy is sufficient to interact with the active site of the IL-13 and has shown to inhibit inflammatory signaling. These computational results confirm epinephrine and guaifenesin as potential ligands showing potential inhibitory activity for IL-13 signaling. This study also suggests the designing of a new ligand and screening of a large cohort of drugs, in the future, to predict the exact mechanism to control the critical feature of asthma (AU)

Benefit of educational intervention on Autoinjector Technique for caregivers and paediatric patients with food allergies: A literature review

Background and objective: The incidence of food allergy among children is on the rise. Children who are diagnosed with a food allergy receive long-term treatment for allergy management from allergy specialists, nurses and dieticians. This management may include the prescription of an adrenaline autoinjector (AAI) if the child is at risk of a severe allergic reaction (ana-phylaxis). Therefore, it is important that parents of children with allergies are trained in the recognition of anaphylaxis and in the correct administration of an AAI. However, many parents are unable to correctly administer an AAI when assessed. The aim of this study is to review the current literature on caregiver’s and paediatric patients’ ability to use an AAI. Methodology: An electronic search to evaluateAAI technique in caregivers and children with food allergy was conducted. A total of 323 articles were screened in which 10 studies were reviewed. Results: Seventy-eight percent of parents who had never been trained in the use of an AAI were unable to trigger it. In studies where paediatric patients’ ability to use an AAI was assessed, a mean score of 7.78/9 was derived for AAI knowledge among adolescents. Conclusion: Caregivers and patient’s ability to use an AAI was inconclusive, and further research should address the validation of an assessment tool for AAI use. A significant improve-ment in AAI use was found after an educational intervention. This highlights the need for improved education for allergic individuals and their caregivers, and further study should explore what are the best educational methods to meet these needs. © 2022 Codon Publications. Published by Codon Publications (AU)

Risk taking and self-care behaviours amongst adolescents and young adults with food allergies

Background: Anaphylaxis is a systemic, life-threatening reaction and its prevalence is rising amongst adolescents and young adults (AYA) with food allergies. The likelihood of fatal ana-phylaxis is disproportionately high in this population. The effective management of anaphy-laxis can be done by adhering to various food allergy-related self-care behaviours, namely avoidance of allergens, carriage and use of adrenaline auto-injectors (AAI). Unfortunately, compliance of AYA to these behaviours is believed to be suboptimal and the likely reason behind their increased rates of fatal anaphylaxis. Methodology: To evaluate the adherence to food allergy-related self-care behaviours amongst adolescents and young adults with anaphylaxis an electronic search was conducted utilizing PubMed, MEDLINE, and CINAHL plus to identify relevant studies. 175 article abstracts were screened, and 26 remained which were read in full to determine which best satisfied the inclusion and exclusion criteria. Ultimately, 10 articles were selected for this review. Results: The compliance to food allergy-related self-care behaviours amongst AYA founded to be suboptimal. AAI design, peer influence, and emotional attitudes of AYA were found to be the most significant factors influencing AYA compliance to self-care behaviours. Conclusions: The adherence of AYA to food allergy-related self-care behaviours is subopti-mal and evidence on the factors affecting AYA compliance has been largely contradictory. AAI design, peer influence, and emotional attitudes are significant factors influencing AYA adherence. Therefore, further research directed at these factors is imperative in facilitating the design of guidelines to maximize the adherence of AYA to food allergy-related self-care behaviours (AU)

Uso de adrenalina en el tratamiento de la hematuria persistente / Use of epinephrine in the treatment of persistent hematuria

La hematuria persistente es un signo habitual en los cuidados paliativos cuyo tratamiento sigue siendo un desafío. En este caso, la hematuria se presentó en una paciente de 78 años anticoagulada en el contexto de una fractura iliopúbica que se complicó con trombosis venosa profunda y tromboembolismo pulmonar. Para el tratamiento, se optó en un primer momento por lavados vesicales continuos con suero fisiológico. Dada la persistencia de la hematuria y la agudización de la anemia, se decidió añadir a los lavados con suero una ampolla de adrenalina. La paciente presentó buena tolerancia hemodinámica al tratamiento con adrenalina y mostró una mejoría clínica significativa, lo que permitió retirar la adrenalina y añadir a los lavados con suero ácido tranexámico (no realizado antes por el riesgo de obstrucción de la sonda por coágulos). Tras dos días con orina de aspecto claro se retiraron los lavados continuos. (AU)

Persistent hematuria is a common sign in palliative care whose treatment is still a challenge. In this case, hematuria occurred in a 78-year-old anticoagulated patient in the context of an iliopubic fracture complicated by deep vein thrombosis and pulmonary thromboembolism. For treatment, the first option was continuous bladder irrigation with saline solution. Given the persistence of hematuria and the worsening anemia, it was decided to add an ampoule of epinephrine to the bladder irrigation with saline solution. The patient presented good hemodynamic tolerance to adrenaline treatment and showed significant clinical improvement. This allowed withdrawal of epinephrine and addition of tranexamic acid to the serum (which was not done before because of the risk of catheter obstruction due to clots). After two days with clear urine, the continuous bladder irrigation were withdrawn. (AU)

Hipocortisolismo hipofisario por sobrecarga férrica en un paciente conAnemia de Blackfan-Diamond / Pituitary hypocortisolism due to iron overload in a patient with Blackfan-Diamond anemia

Iron overload in the context of a Blackfan-Diamond anemia is a extremely uncommon cause of central adrenal insufficiency. We report apatient with Blackfan-Diamond anemia diagnosis during his childhood.Ten years later, as a consequence of iron overload caused by repeatedtransfusions, he developed central hypocortisolism. Blackfan-Diamondanemia is a hereditary syndrome characterized by erythroid aplasia,predisposition to hematologic and solid organ malignancies and congenital abnormalities.Endocrine complications of Blackfan-Diamond anemia are reported inthe literature and highly variable. Hypocortisolism is considered as anuncommon complication (0.7-4 %). Therefore, in a patient with repeated transfusions, we must considerer in a possible ACTH deficiency inthe context of hemochromatosis due to iron overload. (AU)

Las causas de insuficiencia adrenal de origen central son múltiples,siendo la sobrecarga férrica en el seno de una anemia de Blackfan-Diamond extremadamente infrecuente. Se presenta el caso de un pacientede 15 años diagnosticado de anemia de Blackfan-Diamond en la infancia que desarrolla hipocortisolismo de origen central como consecuencia de la sobrecarga férrica por transfusiones de repetición comotratamiento de soporte de la anemia. La anemia de Blackfan-Diamondes un síndrome hereditario caracterizado por una aplasia eritroide queconlleva un recuento reducido de glóbulos rojos, anomalías congénitasy predisposición a neoplasias hematológicas y de órganos sólidos. Laprevalencia de las complicaciones endocrinas reportadas en la literatura secundarias a esta patología es muy variable siendo el hipocortisolismo muy poco frecuente (0,7-4 %).Por ello, ante un paciente contransfusiones de repetición, debemos tener en cuenta el posible déficitde ACTH en en el contexto de una hemocromatosis por sobrecarga férrica. (AU)

Hemodynamic changes during exodontia in hypertensive and normotensive patients following injection of local anesthetics with and without epinephrine: a prospective comparative study / Cambios hemodinámicos durante la extracción en pacientes hipertensivos y normotensivos tras la inyección de anestésicos locales con y sin epinefrina: un estudio comparativo prospectivo

Introduction: Hypertensive patients are frequently encountered in routine dental practice and exodontia procedures. Possibility of cardiovascular complications can be anticipated in these patients. This study compares blood pressure, heart rate, and peripheral capillary oxygen saturation, in normotensive and hypertensive patients prior to, during and after dental extractions. Patients and methods: A prospective comparative study was carried out in 100 (N = 100) patients between the age group of 40-70 years. 50 patients diagnosed with Stage I hypertension and 50 patients who were normotensives, requiring extraction of tooth were recruited. They were further divided into four groups namely, A, B, C and D, each consisting of 25 (n = 25). Group A included patients with controlled hypertension who were administered local anesthesia with epinephrine, while Group B had patients with controlled hypertension who were administered local anesthesia without epinephrine. Group C had normotensive patients who were administered local anesthesia with epinephrine and normotensive patients who were administered local anesthesia without epinephrine were under group D. The patients were evaluated at preoperative, intra operatively and post-operative interval for blood pressure, heart rate and peripheral oxygen saturation. (AU)

Introducción: Con frecuencia, en la práctica dental habitual y en los procedimientos de exodoncia se encuentran pacientes hipertensos. En estos pacientes se pueden anticipar posibles complicaciones cardiovasculares. Este estudio compara la presión arterial, la frecuencia cardiaca y la saturación de oxígeno periférico en pacientes normotensos e hipertensos antes, durante y después de las extracciones dentarias. Pacientes y métodos: Se realizó un estudio comparativo prospectivo en 100 pacientes (n = 100) entre un grupo de edad de 40-70 años. Se reclutaron 50 pacientes con diagnóstico de hipertensión en estadio I y 50 pacientes normotensos que requirieron extracción dentaria. Se dividieron además en cuatro grupos, A, B, C y D, cada uno de los cuales constaba de 25 (n = 25). El grupo A incluyó pacientes con hipertensión controlada a los que se les administró anestesia local con epinefrina, mientras que el grupo B tenía pacientes con hipertensión controlada a los que se les administró anestesia local sin epinefrina. El grupo C tenía pacientes normotensos a los que se les administró anestesia local con epinefrina y los pacientes normotensos a los que se les administró anestesia local sin epinefrina estaban en el grupo D. En el intervalo preoperatorio, intraoperatorio y postoperatorio se evaluaron la presión arterial, frecuencia cardiaca y saturación de oxígeno periférico de los pacientes. (AU)

Oral food challenge in IgE mediated food allergy in eastern Mediterranean children

Background: The oral food challenge (OFC) in IgE mediated food allergy causes anxiety both in parents and in patients due to its inherent risks. Objective: Documentation of the rate, spectrum, and predictors of positive reactions is instructive. Methods: Children, who underwent OFC between January 1, 2017 and December 31, 2019 were analyzed. Results A total of 1361 OFCs in 613 cases were reviewed. Most of them were performed in preschool children (≤2 years 50%) and 55% of them had more than one OFC. Mainly considered food groups were cow’s milk (31.8%), hen’s egg (28.5%), tree nuts (20%), legumes (7%), seeds (4.9%), and wheat (2.7%). The overall OFC positivity was 9.6%, whereas 6.7% with cow’s milk, 4.9% with hen’s egg, 16.1% with tree nuts, 21.6% with wheat, and 32.8% with seeds. The severity scoring revealed grade I (24.4%), II (45.8%), and III (29.7%) reactions. Fifty (38%) cases required epinephrine and four cases required hospitalization. OFCs with sesame seeds (odds ratio [OR]: 7.747, [confidence interval (CI) 95%: 4.03–14.90]), wheat (OR: 3.80, [CI: 1.64–8.84]), and tree nuts (OR: 2.78, [CI: 1.83–4.23]) predicted a positive OFC while a concomitant asthma (OR: 3.61 [CI: 1.27–10.28]) was more likely to elicit anaphylaxis. Conclusion In OFC practice, priority is given to basic nutritional sources and the most frequent food allergens, where preschool children with multiple sensitizations are the primary subjects. Increased risks of positive reactions with sesame, tree nut, and wheat and increased risk of anaphylaxis with concomitant asthma should be considered while performing OFC (AU)

Síndrome de Kounis del tipo II inducido por amoxicilina-ácido clavulánico complicado con encefalopatía hipóxico-isquémica durante anestesia general / Amoxicillin-clavulanic acid-induced type II Kounis syndrome during general anaesthesia complicated with hypoxic-ischaemic encephalopathy

La anafilaxis es un síndrome multisistémico agudo grave que implica la liberación masiva del torrente sanguíneo de mastocitos y mediadores basófilos. Cuando las arterias coronarias son el objetivo principal, se puede sospechar el síndrome de Kounis o, más raramente, el llamado síndrome de Kounis cuando se trata de arterias cerebrales. Las lesiones isquémicas cerebrales pueden resultar de una presión arterial baja o de una acción mediadora proinflamatoria y/o vasoconstrictora directa en el sistema arterial cerebral. El diagnóstico es difícil en pacientes anestesiados. El tratamiento también es un reto, ya que la administración de adrenalina puede empeorar la isquemia. Presentamos un caso de síndrome de Kounis tipo II inducido por amoxicilina-ácido clavulánico bajo anestesia general, complicado con encefalopatía grave e irreversible de origen isquémico.(au)

Anaphylaxis is a severe acute multisystem syndrome involving massive mediator release from mast cells and basophils. Although the entire arterial system can be affected, when coronary arteries are the main targets, Kounis syndrome needs to be considered. Cerebral artery involvement has also been suggested in rarer MC-mediator release episodes; so-called ‘Kounis-like’ syndrome. Cerebral ischaemic lesions can then result from low blood pressure or direct proinflammatory and/or vasoconstrictive mediator action in the cerebral arterial system. Diagnosis can be difficult in anaesthetised patients, as low blood pressure can have multiple causes. Treatment is also challenging, as administering adrenaline can worsen ischaemia. We report the first case of amoxicillin-clavulanic acid-induced type II Kounis syndrome under general anaesthesia, complicated with severe, irreversible and subsequently fatal encephalopathy of ischaemic origin. This case can contribute to awareness of less common Kounis syndrome manifestations, including severe cerebral involvement, or other anaphylactic reactions with atypical presentations.(AU)

Diagnóstico radio-endoscópico de la lesión de Dieulafoy en un divertículo duodenal / No disponible

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Hemostatic agents in endodontic surgery of maxillary molars: A randomized controlled pilot study of polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze versus aluminum chloride

BACKGROUND: Hemostasis is of critical importance in endodontic surgery. Studies on bleeding control in maxillary molars are scarce. The present study compares the efficacy of two hemostatic techniques in controlling bleeding in endodontic surgery. MATERIAL AND METHODS: A randomized two-arm pilot study involving 30 patients with peri-radicular lesions in maxillary molars (first and second molars) was carried out including the following hemostatic agents: polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze (test group; n = 15) and aluminum chloride (Expasyl(TM)) (control; n = 15). Bleeding control was independently assessed by the surgeon and by two blinded observers before and after application of the hemostatic agent, and was classified as either adequate (complete bleeding control) or inadequate (incomplete bleeding control). RESULTS: Bleeding control was similar in both groups. Simple binary logistic regression analysis failed to identify variables affecting bleeding control. Only the height of the keratinized mucosal band (≥ 2 mm) suggested a decreased risk of inadequate bleeding control of up to 89% (OR = 0.11; p = 0.06). CONCLUSIONS: No difference in the efficacy of bleeding control was observed between PTFE strips as an adjunct to epinephrine impregnated gauze and aluminum chloride in maxillary molars

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Utilización rápida y segura de los autoinyectores de adrenalina. ¡Tenemos un problema / Rapid and safe use of adrenaline auto-injectors: We have a problem

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Determinants of low anger control in patients with coronary artery disease

A low anger control has been associated to coronary artery disease (CAD). However, there is scarce information on predictors of low anger control in those patients. All patients scheduled for elective coronary angiography at a tertiary center for cardiology in South Brazil between 11/30/2009 and 02/03/2010 were considered eligible for inclusion. The inclusion criterion was the presence of significant CAD which was defined as the presence of a stenosis >50% in at least one major epicardial artery. Clinical and sociodemographic characteristics of the patients were registered, and anger aspects were assessed by the Spielberger's Anger Expression Inventory. The anger control score was categorized into quartiles, and the lowest quartil was considered and the first quartile (Low Anger Control) was compared with the others (Proper Anger Control). The medians were compared by the POISSON regression with adjustment for single and multiple robust variances. Three hundred and six patients with 60 ± 9 years old with angiographically proven CAD were included in this study. Our results showed that the younger, diabetic and patients with a family history of CAD presented lower medians for the anger control. Body Mass Index was also correlated with anger control. In the multivariate analysis, however, only family history for coronary artery disease was an independent risk factor for a low anger control. These results provide a better understanding of the relationship between anger control and CAD, and should help to consolidate the knowledge in this field and also help to plan further studies to investigate a cause-effect relationship

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Adrenalina y vasopresina para la parada cardiaca / Adrenaline and vasopressin for cardiac arrest

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Epinephrine auto-injectors: information, education, training and acceptance

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Physicians prescribe adrenaline autoinjectors, do parents use them when needed?

Background: Anaphylaxis is a sudden, severe, and potentially life-threatening allergic reaction, affecting a portion of allergic patients. Adrenaline is the first-line medication for anaphylaxis and available in many parts of the world as adrenaline autoinjectors (AAIs). Objective: Aim of this study was to determine attitudes and knowledge levels of patients/parents regarding the use of AAIs, frequency, and rate of appropriate AAI use and to give a standardized and better education by improving on mistakes during administration. Method: 190 patients aged 1-18 years who were prescribed AAIs for any reason between 2012 and 2017 in Hacettepe University Pediatric Allergy Unit. Demographic data were collected during face-to-face interview or by telephone. Parents completed a mini-survey regarding use, carriage, and storage of AAI. Results: Some 190 patients (64.7% male) aged 7.83 (4.99-12.08) years, median (inter-quartile), were included in the study. The indications for AAI prescription were food allergy (78.9%); venom allergy (14.2%); idiopathic anaphylaxis (3.7%); mastocytosis (2.1%); and drug allergy (1.0%). One-fourth of AAI-prescribed patients experienced anaphylaxis requiring the use of AAI within the past five years. However, only 30% of the patients dared to use AAI; only three-quarters of whom had managed to use it correctly. Conclusion: After prescription of AAI and initial training, patients and parents' concerns and fears should be taken into consideration and necessary support should be provided. At every opportunity and each clinical visit, not only should training sessions be repeated but also the patients and parents should be psychologically supported

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Action plan to ensure global availability of adrenaline autoinjectors

Adrenaline (epinephrine) is the first-line treatment for anaphylaxis and, therefore, is listed as an essential medication for the treatment of anaphylaxis by the World Health Organization (WHO). However, the availability of adrenaline autoinjectors (AAI) for use as first-aid treatment is limited to only 32% of all the world's 195 countries, most of which are high-income countries. The key issues leading to the lack of availability of AAIs include cost, national regulations, lack of regional evidence on the value of epinephrine, and limited accurate data about the epidemiology of anaphylaxis. For these reasons, regional and international allergy academies support initiatives to narrow these gaps. Our WHO Collaborating Centre is deeply involved in this process. This document aims to serve as a baseline to ensure the following: (1) adequate access to affordable autoinjectors for all patients/societies; and (2) the development of disease-/patient-specific approaches. Therefore, we propose a 5-step action plan that aims to gather accurate epidemiological data on anaphylaxis and autoinjector consumption, confirm partnerships, strengthen awareness, and include AAIs in the WHO Model List of Essential Medicines. These aspects should be considered in combination. A prioritized research agenda should encapsulate all these steps within the framework a global initiative against anaphylaxis. More than calling for universal availability of autoinjectors for optimal management of anaphylaxis, we propose an action plan as the baseline for a global initiative against anaphylaxis. We strongly believe that combined efforts will ensure a strong public health and societal approach that will lead to optimal care of allergic patients and best practices in allergology

La adrenalina es el tratamiento de primera línea de la anafilaxia y, por lo tanto, está catalogada como un medicamento esencial en su tratamiento por la Organización Mundial de la Salud (OMS). Sin embargo, la disponibilidad de los autoinjectores de adrenalina (AIA), indispensables en las fases iniciales del manejo de la anafilaxia, está limitada a solo el 32% de los 195 países del mundo, en su mayoría países con economías de primer orden. Los problemas clave que conducen a la falta de disponibilidad de los AIA incluyen el costo, pero también la regulación nacional, la falta de evidencia locales sobre el valor de la epinefrina y la escasez de datos precisos sobre la epidemiología de la anafilaxia. Por estas razones, las sociedades científicas de alergia, nacionales e internacionales, dan apoyo a las iniciativas encaminadas a reducir estas brechas. Nuestro Centro Colaborador de la OMS está profundamente involucrado en este proceso y el propósito de este documento es servir de punto de partida para alcanzar: (I) un acceso adecuado a los AIA a un costo asequible para todos los pacientes/sociedades y (II) el desarrollo de un abordaje específico para el binomio paciente/enfermedad. Por todo ello, proponemos un plan de acción en 5 pasos: recopilar datos epidemiológicos de calidad sobre la anafilaxia e indicadores de consumo de AIA, establecer alianzas entre todos los agentes implicados, reforzar la importancia del uso adecuado de los AIA e incluirlos en el listado de medicamentos esenciales de la OMS, que deben darse de forma conjunta. Una agenda de investigación priorizada debe incluir todos estos pasos en el marco de una iniciativa global contra la anafilaxia. Más que exigir la disponibilidad global de los AIA para un mejor abordaje de la anafilaxia, proponemos un plan de acción como base de una iniciativa mundial contra la anafilaxia. Creemos firmemente que estos esfuerzos combinados a nivel de sociedad y de salud pública conllevarán un cuidado óptimo de los pacientes alérgicos y la mejor práctica de la Alergología