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

Emergency anaphylaxis protocols: A cross-sectional analysis of general practice surgeries and pharmacies in both the urban and rural setting in Ireland.

BACKGROUND: The incidence of anaphylaxis appears to be increasing worldwide with cases in the community outnumbering those in the hospital setting. General practice (GP) surgeries and pharmacies, based in the community, are often the first point of contact for many patients suffering from anaphylaxis. OBJECTIVES: To determine if studied GP surgeries and pharmacies have an anaphylaxis protocol on site and have access to an anaphylaxis kit; to explore GP's and pharmacists' personal experiences with management of anaphylaxis. METHODS: A cross-sectional, questionnaire-based study was performed examining anaphylaxis protocols in a sample of general practices and pharmacies from some counties in Ireland. This consisted of a sample from rural and urban settings. The study commenced in October 2014. RESULTS: Nineteen of 24 GPs (79%) and 9 (29%) pharmacies had an anaphylaxis protocol (P < 0.001). Twenty-four (100%) GP practices and 12 pharmacies (39%) surveyed had an anaphylaxis kit on site. Twelve GPs (50%) had treated a patient with anaphylaxis in the surgery while 8 (33%) had treated a patient in the community. One pharmacist (3%) had witnessed anaphylaxis in practice. Two pharmacies and one GP had been contacted by local businesses to alert them to a case of anaphylaxis. CONCLUSION: In contrast to national and international guidelines only 79% of GPs and 29% of pharmacies in this study from Ireland had an anaphylaxis protocol onsite.

Parent perspectives on school food allergy policy.

BACKGROUND: Food allergy affects up to 8% of children in the U.S. There is minimal research to date on food allergy policies that are currently in place in schools and the opinions of parents of children with food allergy on the effectiveness of or need for these policies. METHODS: An electronic survey was disseminated to parents of children with food allergy. Frequencies were calculated to describe respondent characteristics and responses. Chi-square tests were performed to examine associations between school and child characteristics and outcomes. RESULTS: Of the 289 parent respondents, 27.4% were unsure or felt school was unsafe for their child with food allergy. While the majority felt that the polices in their child's school were helpful, most also believed that implementation of additional polices was necessary, including availability of stock epinephrine (94.2%), lunch menus with allergen information (86%), ingredient labels on food items (81%), and direct food allergy education for students (86%). There were significant differences in school food allergy policy depending on the age of the student body, private versus public school, and geographic location. CONCLUSIONS: While most schools reportedly have one or more food allergy policies in place, many parents have concerns over the safety of their child at school and feel that additional policies are necessary to improve the safety of the school environment for children with food allergy. The availability of stock epinephrine, improved allergen labeling of food and menus and increased food allergy education may be key policy areas on which to focus.

[Management of anaphylaxis in Latin America: current situation]. / Manejo de la anafilaxia en América Latina: situación actual.

BACKGROUND: Anaphylaxis is a systemic and severe allergic reaction, which can be fatal. The first-line treatment of choice, according to international guidelines, is intramuscular adrenaline. However, different studies show that the performance of health professionals managing anaphylaxis is often inadequate. OBJECTIVE: To assess the current resources available in Latin American countries for the diagnosis and treatment of anaphylaxis. METHODS: Online survey promoted by the Latin American Society of Allergy and Immunology to representatives of the national allergy societies of Latin American countries. RESULTS: Responses were received from 10 countries out of the 14 countries invited to participate. Only five of the countries have clinical practice guidelines in anaphylaxis. Adrenaline autoinjectors are available only in two countries, Argentina and Brazil, but are not subsidized by public health systems. In all countries, adrenaline is available in ampoules, which is the presentation usually prescribed to patients for self-administration. The use of adrenaline was estimated to be less than 50 % of cases in five countries, while antihistamines and corticosteroids are almost always used. The determination of serum tryptase is possible in some health centers, often private, in five of the countries surveyed. CONCLUSION: It is necessary to improve resources related to the diagnosis and management of anaphylaxis in Latin American countries.

Antecedentes: La anafilaxia es una reacción alérgica sistémica y grave que puede resultar fatal. El tratamiento de elección de primera línea, según las guías internacionales, es la adrenalina intramuscular. No obstante, diferentes estudios muestran que las acciones de los profesionales sanitarios ante un cuadro de anafilaxia frecuentemente son inadecuadas. Objetivo: Analizar los recursos actuales disponibles en los países de América Latina para el diagnóstico y tratamiento de la anafilaxia. Métodos: Encuesta en línea promovida por la Sociedad Latinoamericana de Alergia e Inmunología y realizada a representantes de las sociedades nacionales de alergia de los países de América Latina. Resultados: Se recibieron respuestas de 10 países de los 14 a los que se invitó. Solo en 5 se disponía de guías de práctica clínica en anafilaxia y en 2, Argentina y Brasil, de autoinyectores de adrenalina, no subvencionados por el sistema público de atención a la salud. En todos los países se dispone de adrenalina en ampolletas, que suele prescribirse a los pacientes para autoadministración. Se estimó que la utilización de adrenalina se emplea en menos de 50 % de los casos en 5 países, mientras que los antihistamínicos y los corticoides se utilizan casi siempre. En 5 países, la determinación de triptasa sérica fue posible en algunos centros sanitarios, muchas veces privados. Conclusión: Es necesario mejorar los recursos relacionados con el diagnóstico y tratamiento de la anafilaxia en los países latinoamericanos.

Laboratory Animal Bite Anaphylaxis: A National Survey: Part 2: Treatment Protocols.

OBJECTIVE: This study documents current treatment protocols for laboratory animal bite anaphylaxis in the United States. METHODS: An online survey was e-mailed to designated institutional officials at laboratory animal facilities identified by the National Institutes of Health Office of Laboratory Animal Welfare. RESULTS: One hundred eighty-nine organizations responded to the question of whether they had a treatment protocol with 32% indicating that they had a protocol. Having a case of anaphylaxis increased the likelihood of having a protocol (61%). Of those with a protocol, 58% included treatment with injectable epinephrine, if clinically indicated. Among all respondents, only 14% reported keeping injectable epinephrine at the location where animal work is performed. CONCLUSIONS: A minority of responding organizations had protocols in place to address laboratory animal bite anaphylaxis. Organizations with workers at risk should consider implementing a protocol for assessment and treatment.

Epinephrine Policies and Protocols Guidance for Schools: Equipping School Nurses to Save Lives.

In response to limited direction given by legislative bodies to school nurses about how to implement state-mandated or recommended stock epinephrine programs in their schools, NASN convened a workgroup of invested stakeholders. This workgroup was challenged to equip school nurses with the necessary tools to develop policies and protocols regarding stock epinephrine in their school districts. The dynamic workgroup subcommittees focused on policies, procedures, and reporting tools. This article reviews the results of the subcommittees' work and the overall collaboration within the workgroup. This article provides clear, nationally recognized guidance on the best practice for establishing stock epinephrine policies and protocols with reporting tools at the local school district level.

Availability of emergency drugs and equipment in general and specialist dental settings in Babol, Iran.

AIM: Medical emergencies can frequently happen in dental settings and it is critical to outfit the clinic by emergency drugs and equipment. The aim of this study was to evaluate the emergency drugs and equipment in general and specialist dental settings in Babol, Iran. MATERIALS AND METHODS: A questionnaire containing closed ended questions about the available emergency drugs and equipment was used in this descriptive-analytical study. Data were subjected to descriptive analysis using SPSS 18.0 to identify the most frequent drugs and equipment. Chi-square and t-test were used to evaluate the correlation between the variables. p < 0.05 was considered statistically significant. RESULTS: One hundred and twelve dentists answered the questionnaire. The most available drug and equipment were epinephrine (67%) and single use syringe (81.3%) respectively. Significant correlation was found between degree of education and availability of first group of emergency drugs and between sex and possession of second group of emergency equipment (p < 0.05). CONCLUSION: Degree of availability of emergency drugs and equipment was moderate to low and training about emergencies should be included in the didactic topics of universities and workshops. CLINICAL SIGNIFICANCE: Information about emergency drug and equipment would help to manage the unwanted emergency situations.

Anaphylaxis. How often patients carry epinephrine in real life?

BACKGROUND: Epinephrine is an important life-saving treatment in patients with anaphylaxis. OBJECTIVE: To evaluate how many patients with a history of anaphylaxis, carry epinephrine with them during medical consultation. MATERIAL AND METHODS: A prospective study was done in the Allergy Unit of the University of Antioquia (Medellin, Colombia), we recruited patients, of all ages, from August 2012 to June 2013, who were referred with suspected anaphylactic reaction for the last 18 months, and were asked about carrying epinephrine with them. RESULTS: Among 120 patients with a history of anaphylaxis, only 69 (57.5%) had epinephrine in their house or office, and 33 (27.5%) carried it in the medical consultation after 6 months of being prescribed. CONCLUSIONS: Most patients with a history of anaphylaxis do not carry epinephrine with them all the time, and it is necessary to advise the patients, to improve their compliance to treatment.

ANTECEDENTES: la epinefrina es un tratamiento importante en los pacientes con anafilaxia. OBJETIVO: evaluar cuántos pacientes con antecedentes de anafilaxia portaban la epinefrina durante la consulta médica. MATERIAL Y MÉTODOS: estudio observacional efectuado en la Unidad de Alergología de la Universidad de Antioquia, Medellín, Colombia, entre agosto de 2012 y junio de 2013. Preguntamos a los pacientes con antecedente de reacción anafiláctica en los últimos 18 meses si portaban, o tenían en su casa, epinefrina para autoaplicación en caso de sufrir anafilaxia. RESULTADOS: de 120 pacientes con antecedente de anafilaxia, sólo 69 (57.5%) tenían adrenalina en la casa o en el lugar de trabajo, y 33 (27.5%) portaban la adrenalina durante la consulta, luego de seis meses de haber sido prescrita. CONCLUSIONES: la mayoría de los pacientes con antecedente de anafilaxia no portan epinefrina para autoinyección, y consideramos necesario mejorar el apego al tratamiento en este grupo de pacientes.

Preparedness for students and staff with anaphylaxis.

BACKGROUND: Schools are responsible for handling life-threatening events due to a variety of conditions, including anaphylaxis. California is one of a few states that permits school districts to stock emergency epinephrine auto-injectors and to train unlicensed assistive personnel to administer epinephrine for a life-threatening event. We surveyed school nurses in California to explore their experience with life-threatening anaphylaxis, implementation of allowable stock epinephrine auto-injector programs, and the barriers to program implementation. METHODS: An exploratory, cross-sectional, descriptive design was used for this study. Data was obtained from a convenience sample of 171 credentialed California school nurses via an online survey service. Descriptive statistics and Pearson's chi-square were used to analyze the data. RESULTS: Thirty percent of school nurses reported using 1 student's prescribed medication to rescue another student in distress. Despite the frequency of using another student's rescue medication and California's permissive policy, only 13% of nurses reported having stock epinephrine programs. Barriers to stock epinephrine programs included: (a) limited availability of school nursing services, (b) lack of policies or guidelines, (c) inadequate funding for training and medication, and (d) lack of education. Limited awareness of susceptibility and the immediate life-threatening nature of anaphylaxis were also contributing factors. CONCLUSIONS: Legislative initiatives are sufficient to develop safe, effective policies and protocols to manage life-threatening allergic reaction in schools. The findings indicate that more education is needed for school personnel and research is needed to determine an effective mechanism to remove barriers for emergency care during school hours.