Estudio primario

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Evaluation of an anaphylaxis training program for unlicensed assistive personnel.

Año 2004
Autores Litarowsky JA , Murphy SO , Canham DL
Revista The Journal of school nursing : the official publication of the National Association of School Nurses
Enlaces Pubmed
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This study evaluated a training program designed to prepare unlicensed assistive personnel (UAP) in high school settings to recognize and respond effectively to an anaphylactic emergency. Subjects included 53 adults employed by a high school district in the San Francisco Bay Area of California. A training model was developed based on Bandura's theory of sources of self-efficacy. Knowledge and perceived self-efficacy of participants were measured before and after the training program to determine if a theory-based anaphylaxis recognition and epinephrine auto-injector training program would increase participants' knowledge and self-efficacy in responding to an anaphylactic emergency. Paired t tests revealed significant improvement in scores for both knowledge and perceived self-efficacy following the intervention (p < .001). This theory-based training program offers a valuable model for other school nurses in providing knowledge and skill training for unlicensed assistive personnel in other health emergencies.

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Estudio primario

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Intraoperative anaphylaxis to sugammadex and a protocol for intradermal skin testing.

Año 2014
Revista Anaesthesia and intensive care
Enlaces Pubmed
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Sugammadex is a selective binding agent for aminosteroid neuromuscular blockers whose use is increasing in anaesthetic practice. We present three cases of severe anaphylaxis coincident with sugammadex administration. Subsequent intradermal testing confirmed sugammadex as the triggering agent, with all patients having positive skin responses to a 1:100 dilution of the standard 100 mg/ml solution and two out of three having a positive response to a 1:1000 dilution. As all patients were administered sugammadex to reverse neuromuscular blockade with rocuronium, we considered that sugammadex-rocuronium complexes were a potential unique allergen. In the two patients who were additionally tested with a rocuronium-sugammadex (3.6:1 molecular ratio) mixture, the wheal-and-flare response was significantly attenuated.

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Estudio primario

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Cetirizine-induced anaphylaxis: a rare adverse drug reaction.

Año 2009
Revista British journal of clinical pharmacology
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Estudio primario

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Serious shortcomings in the management of children with anaphylaxis in Scottish schools.

Año 2006
Autores Rankin KE , Sheikh A
Revista PLoS medicine
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BACKGROUND:

The United Kingdom incidence of anaphylaxis has increased very sharply over the last decade, with the highest rates of hospital admissions occurring in school-aged children. This raises concerns about the extent to which schools are aware of approaches to the prevention and treatment of anaphylaxis.

METHODS AND FINDINGS:

We undertook a national postal survey of 250 Scottish schools enquiring about approaches to managing children considered to be at risk of anaphylaxis. We obtained responses from 148 (60%) schools, 90 (61%) of which reported having at least one at risk child. Most (80%) schools with children considered to be at risk reported having personalised care plans and invariably reported having at least one member of staff trained in the emergency treatment of anaphylaxis. Access to adrenaline was available on-site in 97% of these schools. However, significantly fewer schools without children considered to be at risk reported having a trained member of staff (48%, p < 0.001), with access to adrenaline being very poor (12%, p < 0.001). Overall, 59% of respondents did not feel confident in their school's ability to respond in an emergency situation.

CONCLUSIONS:

Most schools with children considered to be at risk of anaphylaxis report using personal care plans and having a member of staff trained in the use of, and with access to, adrenaline. The picture is, however, less encouraging in schools without known at risk children, both in relation to staff training and access to adrenaline. The majority of schools with at risk children have poorly developed strategies for preventing food-triggered anaphylaxis reactions. There is a need for detailed national guidelines for all schools, which the Scottish Executive must now ensure are developed and implemented.

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Estudio primario

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Anafilaxia oral por alimentos contaminados por ácaros: (síndrome de las panquecas)

Traducción oficial
Año 2011
Revista Gac. méd. Caracas
Enlaces Virtual Health Library
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La anafilaxia oral por ácaros es un nuevo síndrome caracterizado por síntomas alérgicos graves que se presentan en individuos alérgicos rápidamente después de la ingestion de alimentos confeccionados con harinas de trigo contaminadas con ácaros. Este síndrome más común en ambientes tropicales, es desencadenado más frecuentemente por panquecas y por ello ha sido designado "el síndrome de las panquecas". Se postula que los alergenos responsables son alergenos termorresistentes ya que los alimentos cocinados son capaces de inducir los síntomas. Una variedad del síndrome puede presentarse durante el ejercicio físico (anafilaxia inducida por ejercicio asociada a la ingestión de polvo con ácaros). Se recomienda conservar las harinas de trigo en el refrigerador para prevenir la proliferación de los ácaros y la aparición del cuadro clínico.

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Revisión sistemática

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Key components of anaphylaxis management plans: Consensus findings from a national electronic Delphi study

Año 2010
Autores Worth A , Nurmatov U , Sheikh A
Revista JRSM short reports
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Objectives: There is no international consensus on the components of anaphylaxis management plans and responsibility for their design and delivery is contested. We set out to establish consensus among relevant specialist and generalist clinicians on this issue to inform future randomized controlled trials. Design: A two-round electronic Delphi study completed by a 25-person, multidisciplinary expert panel. Participants scored the importance of a range of statements on anaphylaxis management, identified from a systematic review of the literature, on a five-point scale ranging from 'very important' to 'irrelevant'. Consensus was defined a priori as being achieved if 80% or more of panel members rated a statement as 'important' or 'very important' after Round 2. Setting: Primary and secondary care and academic settings in the UK and Ireland. Participants: Twenty-five medical, nursing and allied health professionals. Main outcome measures: Consensus on the key components of anaphylaxis management plans. Results: The response rate was 84% (n = 21) for Round 1 and 96% (n = 24) for Round 2. The key components of emergency care on which consensus was achieved included: awareness of trigger factors (100%); recognition and emergency management of reactions of different severity (100%); and clear information on adrenaline (epinephrine) use (100%). Consensus on longer-term management issues included: clear written guidelines on anaphylaxis management (96%); annual review of plans (87%); and plans that were tailored to individual needs (82%). Conclusions: This national consensus-building exercise generated widespread agreement that emergency plans need to be simple, clear and generic, making them easy to implement in a crisis. In contrast, long-term plans need to be negotiated between patient/carers and professionals, and tailored to individual needs. The effectiveness of this expert-agreed long-term plan now needs to be evaluated rigorously. © 2010 Royal Society of Medicine Press.

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Revisión sistemática

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Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis.

Año 2013
Revista Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
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BACKGROUND:

Food allergy is a common cause of anaphylaxis, but the incidence of fatal food anaphylaxis is not known. The aim of this study was to estimate the incidence of fatal food anaphylaxis for people with food allergy and relate this to other mortality risks in the general population.

METHODS:

We undertook a systematic review and meta-analysis, using the generic inverse variance method. Two authors selected studies by consensus, independently extracted data and assessed the quality of included studies using the Newcastle-Ottawa assessment scale. We searched Medline, Embase, PsychInfo, CINAHL, Web of Science, LILACS or AMED, between January 1946 and September 2012, and recent conference abstracts. We included registries, databases or cohort studies which described the number of fatal food anaphylaxis cases in a defined population and time period and applied an assumed population prevalence rate of food allergy.

RESULTS:

We included data from 13 studies describing 240 fatal food anaphylaxis episodes over an estimated 165 million food-allergic person-years. Study quality was mixed, and there was high heterogeneity between study results, possibly due to variation in food allergy prevalence and data collection methods. In food-allergic people, fatal food anaphylaxis has an incidence rate of 1.81 per million person-years (95%CI 0.94, 3.45; range 0.63, 6.68). In sensitivity analysis with different estimated food allergy prevalence, the incidence varied from 1.35 to 2.71 per million person-years. At age 0-19, the incidence rate is 3.25 (1.73, 6.10; range 0.94, 15.75; sensitivity analysis 1.18-6.13). The incidence of fatal food anaphylaxis in food-allergic people is lower than accidental death in the general European population.

CONCLUSION:

Fatal food anaphylaxis for a food-allergic person is rarer than accidental death in the general population.

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Revisión sistemática

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A systematic review and cost-effectiveness analysis of specialist services and adrenaline auto-injectors in anaphylaxis.

Año 2013
Revista Health technology assessment (Winchester, England)
Enlaces PMC , DOI , Pubmed
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BACKGROUND:

Anaphylaxis is a severe, life-threatening generalised or systemic hypersensitivity reaction with high mortality. Specialist services (SSs) are believed to reduce anaphylaxis recurrence and improve use of adrenaline injectors (AIs), which can reduce mortality if used correctly and in time.

OBJECTIVES:

To review the evidence on which persons are at high risk of anaphylactic episodes, the effects of history-taking (including signs, symptoms and physical examination) for anaphylaxis, and when (suspected) patients should be referred. To assess the cost-effectiveness of SS compared with standard care (SC) with or without prescription of AIs.

DATA SOURCES:

In order to assess the clinical effectiveness, 10 databases [Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA), NHS Economic Evaluation Database (NHS EED), Science Citation Index (SCI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, from inception up to March 2011] were searched without data restriction in order to identify relevant studies [randomised controlled trials (RCTs), controlled clinical trials, observational studies, prognostic studies using a multivariate model] written in English.

REVIEW METHODS:

Standard review methods were applied for the assessment of clinical effectiveness. A Markov model, validated by clinical experts, was constructed, which modelled anaphylaxis according to trigger: either food, drug, insect or idiopathic. Anaphylaxis mortality was modelled as a function of time to die and time for emergency response. Probabilistic sensitivity analysis on key parameters was performed.

RESULTS:

From the systematic review, 11,058 references were identified by the searches for studies assessing the clinical effectiveness. In total, 107 papers were obtained, and five prospective observational studies, including 1725 patients, were included. These studies estimated the risk of recurrence to be between 30% and 42.8%. In children (< 12 years), an overall recurrence of 27% was reported, with food being the most frequent allergen (71%). From the cost-effectiveness analysis (CEA), SC with injectors was dominated by SS with or without injectors. SS with no injectors would be cost-effective if the threshold for a quality-adjusted life-year (QALY) was greater than about £740 and with injectors would be cost-effective if the threshold was > £1800. These results were robust to all sensitivity analyses except at relatively extreme values of a small number of parameters.

LIMITATIONS:

Limitations of the study include the low yield from the systematic review; in particular there were no good-quality studies of either SSs or AI effectiveness. This implied a great reliance on expert opinion in the CEA. However, this was appropriately addressed using sensitivity analysis.

CONCLUSIONS:

Only five observational studies assessing clinical effectiveness were identified. Owing to the lack of good data to inform the effectiveness of anaphylaxis intervention, we recommend considerations of RCTs or at least well-designed observational studies of the components of care in SSs. The results of the CEA showed that SS with AIs was cost-effective at a threshold of £20,000 per QALY. More well-designed prospective studies on the effectiveness of SSs are needed to confirm these findings.

FUNDING:

The National Institute for Health Research Health Technology Assessment programme.

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Estudio primario

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Anaphylaxis and epinephrine auto-injector training: who will teach the teachers?

Año 1999
Autores Grouhi M , Alshehri M , Hummel D , Roifman CM
Revista The Journal of allergy and clinical immunology
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BACKGROUND:

Anaphylaxis is the most urgent clinical immunologic event. Effective treatment is best achieved by administration of epinephrine. Accidental exposure to the responsible allergen is the most common cause of anaphylaxis, and because it could be fatal within minutes, epinephrine in preloaded syringes and auto-injectors has been introduced. In our experience patients and medical personnel are not familiar with the use of this device.

OBJECTIVE:

We sought to assess community-based professionals' knowledge of epinephrine auto-injector use and their ability to educate patients.

METHODS:

Study participants consisted of a medical convention's delegates and emergency department personnel in metropolitan Toronto, as well as pharmacists of the target hospitals and retail pharmacists. Research assistants approached eligible professionals to fill out a questionnaire and demonstrate their ability to use a standard placebo auto-injector trainer.

RESULTS:

A total of 122 professionals (composed of emergency physicians, family practitioners, and pediatricians) consented to participate in this study. The majority of participants (81%) did not have a placebo trainer to educate their patients; 76% did not know the 2 available dose strengths. To provide instructions and reinforcement, physicians clearly must have the necessary skills and knowledge, yet only 25% of the study participants were able to demonstrate the 3 steps of injection correctly.

CONCLUSION:

Our study highlights a specific and important deficiency in medical professionals' care of patients at risk for anaphylaxis. The results challenge the current methods of educating professionals, as well as patients, when prescribing or using epinephrine auto-injectors. Clearly a new approach to educating and maintaining such skills is required.

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Estudio primario

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Mephentermine triggered anaphylaxis in the peri-operative period: An unusual occurrence.

Año 2013
Autores Samanta S , Paul M , Samanta S
Revista Saudi journal of anaesthesia
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