Epinephrine auto-injector for anaphylaxis in food allergic patients
Year: 2016
Type: dissertation
Study design: Observational Study
Abstract: Food allergy is one of leading causes of anaphylaxis. Currently there is no treatment for food allergy. It is therefore important that patients and health-care providers are capable of recognizing a severe food-allergic reaction and treating it adequately. The prevalence of food allergy in Dutch high-risk food-allergic adolescents has not increased appreciably in the last six years. The calculated questionnaire-based prevalence of probable food allergy was 6.2%. All food-allergic patients at high risk of anaphylaxis should carry an epinephrine auto-injector (EAI) at all times. In the last six years high-risk food-allergic patients having an EAI has improved marginally, however, there is still a substantial under prescription of EAIs in the Netherlands. The under prescription of EAIs may be partly due to general practitioners not prescribing this medication to patients for whom it would be appropriate to do so. Even when these patients, adolescents in particular, have been prescribed an EAI they do not always carry their EAI, and often do not use their EAI in the event of emergency situations. Successful treatment of anaphylaxis in the community relies on early and correct use of EAIs. In the Netherlands pharmacists supply EAIs to food-allergic patients and have a crucial role in instructing patients in how and when to use an EAI. However, those patients who receive their EAI from a Dutch pharmacy are often not or incorrectly instructed on how to use an EAI. Food allergy, anaphylaxis and having to carry an EAI at all times has a significant impact on quality-of-life of patients. Important predictors for adults were self-perceived disease, type of allergenic food, type of symptoms, and gender, and for children this were type of allergenic food and country of origin. Surprisingly, experiencing anaphylaxis or being prescribed an EAI did not seem to be related to quality-of-life of either food allergic adults or children. The time during which children are observed following a double-blind, placebo-controlled food challenge (DBPCFC) varies in clinical practice. Recommendations vary from between 2 to 24 hours. We showed that late reactions in food allergic children and adolescents after DBPCFC do occur, are poorly predictable and are generally not severe. In our study no severe late reactions were reported. Therefore, it is probably not necessary to observe food allergic children for more than two hours after DBPCFC except following exceptionally severe immediate reactions.
Author: Jacquelien Langenberg
Language: English
Subfield: Immunology and Allergy
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2573659316