Dissemination of EAACI food allergy guidelines using a flexible, practical, whole school allergy awareness toolkit

Essential Pharmaceutical Drugs in the Filler Emergency Kit

INTRODUCTION

The rise in clinical procedures utilizing dermal fillers necessitates preparedness for potential emergencies. Effective management of complications arising from filler use, including vascular occlusions and allergic reactions, hinges on the availability of the appropriate pharmacological supplies.

METHODS

A two-tiered search in PubMed and Google Scholar was conducted to identify essential drugs for dermal filler emergencies. An initial 10-year review used keywords "Dermal Fillers," "vascular occlusion," and "hyaluronidase," followed by a targeted search on "Resuscitation guidelines," "anaphylaxis management," "allergy fillers," and "lidocaine." This article outlines the critical drug inventory for emergency kits to manage filler-related complications effectively.

RESULTS

An ORA classification system (Obligatory, Recommended, Advisable) is introduced to categorize essential drugs according to urgency and clinical necessity. The required drugs are grouped based on their application in cases of vascular occlusion without ocular involvement, vascular occlusion with ocular involvement, anaphylactic reactions, cardiopulmonary resuscitation and hemodynamic disorders, delayed reactions, and aseptic, oxygen, and topical treatments. Additionally, the importance of meticulous drug inventory management-including tracking of stock entry, exit, and expiration dates-is emphasized to reduce the risk of shortages.

CONCLUSION

Ensuring that filler emergency kit is well stocked with vital pharmacological supplies is imperative for effective emergency management during filler procedures. Adopting systematic inventory practices and utilizing the ORA classification can enhance preparedness and patient safety.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Understanding the needs of children and young people with food hypersensitivities: A qualitative study

BACKGROUND

Research has highlighted the psychosocial impact of living with food hypersensitivities (FHS) on children and young people (CYP). However, there is a paucity of qualitative data from CYP themselves in terms of the support they would like to receive to improve their psychological well-being.

OBJECTIVE

To further understand firsthand the experiences of CYP with FHS including the challenges they face and to inform structural changes in how their psychological well-being is supported.

METHODS

CYP aged 8 to 17 years were recruited with self-reported food allergy or celiac disease and asked about their experiences of living with and the psychological impact of FHS, through online, semistructured interviews. Interviews were transcribed verbatim, and data were analyzed using reflexive thematic analysis.

RESULTS

A total of 25 CYP participated in the interviews. Three themes were generated, which addressed an aspect of change that CYP felt would enable support and improve their well-being: desire to feel heard, need for control, and appreciation of the severity of their FHS.

CONCLUSION

This is the first study to investigate what CYP with FHS would find beneficial for their psychological well-being with recommendations provided as to how these may be implemented across various systems. Recommendations include health professionals being more aware of the psychosocial impact from diagnosis, schools being more open and consistent with FHS management strategies, and friends being educated on the management of FHS.

Investigating awareness and implementation of adrenaline auto-injectors (AAI) via the 'Spare Pens in Schools' scheme in Wales: a cross-sectional pilot study

OBJECTIVE

To investigate awareness and implementation of the Spare Pens (ie, adrenaline auto-injectors (AAIs)) scheme in primary and secondary schools in two regions in Wales.

DESIGN

A cross-sectional pilot study employing a mixed research methods approach was carried out.

SETTING AND PARTICIPANTS

State primary and secondary schools within Swansea and Pembrokeshire regional authorities were invited to take part. For geographical context, Swansea is the second largest city in Wales and is situated in the southwest of the country. Pembrokeshire is located in West Wales, with a large rural population outside of its main towns.

MAIN OUTCOME MEASURES

Awareness and implementation of the Spare Pens in Schools scheme. Additionally, compliance with national guidance was measured by administering a questionnaire capturing data on registers, procedures, storage and training in the use of AAIs.

RESULTS

35 schools (30 primary, 5 secondary) participated, with 11% and 6% reporting awareness and implementation of the scheme, respectively. No significant differences in awareness or implementation of the scheme were revealed for school type or region. Secondary schools reportedly stored more AAI devices compared with primary schools. The location of stored AAIs varied by school type, with 46.7% of primary schools storing AAIs in the classroom while 80% of secondary schools stored AAIs in the school office. Procedures for accessing AAI training differed, with 83% of primary schools receiving training by school nurses and 60% of secondary schools accessing training via an allergy team.

CONCLUSIONS

The overall poor awareness of the Spare Pens in Schools scheme has resulted in a worrying lack of implementation of generic AAI devices. An urgent review of information dissemination regarding the scheme is required.

Varying Approaches to Management of IgE-Mediated Food Allergy in Children Around the World

Food allergy is a chronic disease that affects individuals of all ages and is a significant public health problem globally. This narrative overview examines clinical management strategies for IgE-mediated food allergy in children around the world to understand variations in practice. Information was drawn from clinical practice guidelines, recent research, the websites of professional and governmental bodies with expertise in food allergy, and clinical experts from a broad cross-section of geographical regions. The structure and delivery of clinical services, allergen avoidance and food labeling, and resources to support the management of allergic reactions in the community are discussed in detail. The adoption of emerging food immunotherapies is also explored. Wide variations in clinical management of food allergy were apparent across the different countries. Common themes were continuing issues with access to specialist care and recognition of the need to balance risk reduction with dietary and social restrictions to avoid unnecessary detrimental impacts on the quality of life of food allergy sufferers. Findings highlight the need for standardized presentation of practice and priorities, and may assist clinicians and researchers when engaging with government and funding agencies to address gaps.

A practical toolbox for the effective transition of adolescents and young adults with asthma and allergies: An EAACI position paper

INTRODUCTION

Adolescence is a critical stage of rapid biological, emotional and social change and development. Adolescents and young adults (AYA) with asthma and allergies need to develop the knowledge and skills to self-manage their health independently. Healthcare professionals (HCP), parents and their wider network play an essential role in supporting AYA in this process. Previous work showed significant limitations in transition care across Europe. In 2020, the first evidence-based guideline on effective transition for AYA with asthma and allergies was published by EAACI.

AIM

We herein summarize practical resources to support this guideline's implementation in clinical practice.

METHODS

For this purpose, multi-stakeholder Task Force members searched for resources in peer review journals and grey literature. These resources were included if relevant and of good quality and were pragmatically rated for their evidence-basis and user friendliness.

RESULTS

Resources identified covered a range of topics and targeted healthcare professionals, AYA, parents/carers, schools, workplace and wider community. Most resources were in English, web-based and had limited evidence-basis.

CONCLUSIONS

This position paper provides a valuable selection of practical resources for all stakeholders to support effective transitional care for AYA with asthma and allergies. Future research should focus on developing validated, patient-centred tools to further assist evidence-based transition care.

Beliefs about food allergies in adolescents aged 11-19 years: A systematic review

Aims

Research suggests of people with food allergy (FA), adolescents have the highest risk of fatal allergic reactions to food, yet understanding of this population and how they manage their condition is limited. Understanding beliefs and how they affect behaviour could inform ways to reduce risk taking behaviour and fatal reactions in adolescents. This systematic review aimed to explore beliefs adolescents hold about their FA, and how these may be associated with FA management.

Demographics

Adolescents aged 11-19 years with FA.

Methodology

A systematic search of seven databases was conducted. Papers of any design were included that reported on the beliefs about FA in adolescents aged 11-19 years. Data was systemised by narrative thematic analysis.

Findings

20 studies were included. Themes included navigating FA in different environments, carriage and use of adrenaline auto-injectors, management of the risk of anaphylaxis, behaviour and understanding of others, and food-allergic identity.

Implications

Adolescents with FA hold a variety of condition beliefs; some beliefs were related to behaviour that could lead to an allergic reaction, while other beliefs were related to protective behaviours. Further research into understanding adolescent beliefs in order to inform clinical management and reduce the risk of potential fatal reactions is essential.

EAACI guidelines: Anaphylaxis (2021 update)

Anaphylaxis is a clinical emergency which all healthcare professionals need to be able to recognize and manage. The European Academy of Allergy and Clinical Immunology Anaphylaxis multidisciplinary Task Force has updated the 2014 guideline. The guideline was developed using the AGREE II framework and the GRADE approach. The evidence was systematically reviewed and recommendations were created by weighing up benefits and harms. The guideline was peer-reviewed by external experts and reviewed in a public consultation. The use of clinical criteria to identify anaphylaxis is suggested with blood sampling for the later measurement of tryptase. The prompt use of intramuscular adrenaline as first-line management is recommended with the availability of adrenaline autoinjectors to patients in the community. Pharmacokinetic data should be provided for adrenaline autoinjector devices. Structured, comprehensive training for people at risk of anaphylaxis is recommended. Simulation training and visual prompts for healthcare professionals are suggested to improve the management of anaphylaxis. It is suggested that school policies reflect anaphylaxis guidelines. The evidence for the management of anaphylaxis remains mostly at a very low level. There is an urgent need to prioritize clinical trials with the potential to improve the management of patients at risk of anaphylaxis.