Epinephrine autoinjector availability among children with food allergy

Food Allergy Education and Management in Early Learning and Childcare Centres: A Scoping Review on Current Practices and Gaps

Anaphylaxis has occurred in preschools/schools yet there are no consistent food allergy (FA) management practices in early learning and childcare centres (ELCC) across jurisdictions. Presently, there are no reviews that have synthesized FA-related knowledge and management practices within ELCC. We aimed to perform a scoping review of FA management in ELCC, and report on perceived gaps or barriers. A PRISMA-ScR-guided search was conducted for North American, European and Australian articles in English/French in the OVID-MedLine, Scopus, and PsycInfo databases. Two independent reviewers screened the titles/abstracts of 2010 articles and full-text screened 77 articles; 15 of which were specifically related to ELCC. If the two reviewers could not agree to the relevance of a given study, a third reviewer provided guidance. This third reviewer also screened French articles. Thematic and descriptive reports of the studies were presented. We reported solely on pre-Coronavirus Disease pandemic ELCC studies. We included ten articles in this review, which provide evidence that ELCC staff have variable baseline knowledge, comprehension, experience, and practices in place to manage FA. ELCC staff also have limited FA-related training and experience regarding administration of epinephrine auto-injectors (EAI). Emergency Anaphylaxis Plans (EAP) were described in four studies. One study reported the parental influence on the site's food purchasing and FA management. Three studies provided educational interventions, which demonstrated increased and sustained FA-related knowledge and confidence post-intervention. Participants deemed the training beneficial and desired annual training and more FA resources to be available. Across jurisdictions, ELCC staff have provided care and administered EAI in emergencies, but training remained variable. Communication and care planning amongst ELCC staff, and parents, is crucial. Annual education, available EAI and EAPs are tools necessary for effectively managing emergencies.

Self-injectable epinephrine: doctors' attitude and patients' adherence in real-life

PURPOSE OF REVIEW

Epinephrine is the only life-saving treatment of anaphylaxis. Prescription and administration rates of self-injectable epinephrine are generally low. It is unclear whether this is because of availability, low prescription rates, fear of using epinephrine, or a combination of these issues.

RECENT FINDINGS

This review focuses on what self-injectable epinephrine devices (SIED), such as auto-injectors and prefilled syringes, are preferred by patients and healthcare professionals (HCP). Our findings suggest that a device's ease to use, proper and frequent training on its operability, and availability have an impact on preferences and adherence to treatment with SIEDs. After prescribing a patient with a SIED, clinicians should emphasize its use in anaphylaxis, educate patients/caregivers to identify anaphylaxis and on how to use the SIED, and encourage constant practicing with training devices.

SUMMARY

Epinephrine is the sole recommended anaphylaxis treatment and SIEDs are of critical usefulness in the community setting. Further studying of these devices is needed to optimize education for HCPs and patients and their accessibility to SIEDs.

Camp Leadership Perspectives on Food Allergy-Related Anaphylaxis Events and Training for Camp Staff: A National Survey of Summer Camps

BACKGROUND

Training of camp staff to recognize and treat anaphylaxis is recommended because food allergies are prevalent among summer campers. The frequency of food allergy anaphylaxis events and the extent of anaphylaxis training for camp staff are unknown.

OBJECTIVE

To estimate the frequency of food-allergic reactions in camps across the United States and to assess the state of food allergy anaphylaxis training for camp staff.

METHODS

We partnered with CampDoc.com to send a 20-question survey in February 2016 to camp leadership representing 528 camps. Questions addressed demographic characteristics, food allergy policies, training, medication availability, anaphylaxis events, and confidence in staff to recognize and treat anaphylaxis.

RESULTS

A total of 559 responses were received, representing 258 camps. The majority surveyed (n = 529 [94.6%]) reported food-allergic children attending their camps. Only 47.6% (n = 266) respondents reported requiring individualized emergency action plans as required for camper attendance. Anaphylaxis treated with epinephrine was reported by 24% (n = 134) of leadership within the previous 2 years at their camp. These respondents were more likely to have a training session for staff (odds ratio, 2.46; 95% CI, 1.4-4.3). A total of 63.3% (n = 354) reported training session presence. However, 15.6% (n = 87) of leadership were unsatisfied with training materials and one-third were not confident in staff to manage anaphylaxis.

CONCLUSIONS

Appropriate policies to manage food anaphylaxis events and anaphylaxis management training were missing in a substantial proportion of camps. Camp-tailored food allergy training is needed given the number of camps reporting food allergy reactions requiring epinephrine.

Barriers to the Administration of Epinephrine in Schools

BACKGROUND

Anaphylaxis is a serious and growing concern in the school setting as the prevalence of food allergies and food-induced severe allergic reactions continues to increase.

METHODS

A cross-sectional, web-based survey was conducted regarding anaphylactic events that occurred during the 2014-2015 school year. Eligible schools were enrolled in the EPIPEN4SCHOOLS^® program (Mylan Specialty L.P., Canonsburg, PA), which provides free epinephrine auto-injectors to qualifying US schools. Participating schools completed a 29-item survey on anaphylactic event occurrence and treatment, epinephrine stock, school policies regarding anaphylaxis, school staff training, and school nursing coverage.

RESULTS

Responses were provided by 12,275 schools. Epinephrine was administered on school property for 63.7% of reported anaphylactic events (1272/1998). In 38.5% (235/610) of events for which epinephrine was not used, antihistamines were cited as the reason. Only 59.4% of schools cited epinephrine as their standard first-line therapy for anaphylaxis. School nurses were most likely to be trained in anaphylaxis recognition and permitted to administer epinephrine; however, just 53.6% of schools had a full-time nurse on staff.

CONCLUSIONS

Process-related barriers to the appropriate use of epinephrine go beyond access to medication. Widespread staff training and review of school policies are needed to ensure that anaphylaxis is appropriately managed in schools.

Individual healthcare plan for allergic children at school: Lessons from a 2015-2016 school year survey

BACKGROUND

The individual healthcare plan (IHP) was implemented in schools in France in 2003 to improve management of allergic children. Our objectives were to assess the practical aspects of IHP (excluding asthma) and allergic reactions occurring at school.

METHODS

Prospective study conducted in the North Department (France) during the 2015/2016 school year. Two questionnaires were developed: one for the school doctors (n = 67) and one for the school principals (n = 2372).

RESULTS

Data from 336 (25%) of the 1325 IHPs (0.24% of children) were collected (mean age: 8 years; food allergy [FA]: 94% [peanut = 44%, nuts = 54%], venom: 4%). Wide variations in emergency kit (EK) medications were observed: antihistamines (84%), oral corticosteroids (79%), adrenaline auto-injectors (70%), and inhaled bronchodilators (65%). Six hundred and seventy (28%) school principals' responses, representing 81% of all IHPs, were analyzed. A total of 1935 EKs were stored (mean: 2.8/school), one or more with adrenaline, by 213 (32%) schools: in the class room (33%), the nursery (14%), or the principal's office (10%). Sixty, mainly, mild-to-moderate allergic reactions (adrenaline injection: 2) occurred in 44 schools (0.09/school/year), in children with previously undocumented allergy in 50%. FA was highly suspected in 92%.

CONCLUSION

Individual healthcare plan is mainly implemented for FA. Anaphylaxis remains rare in the school setting, and FA is often a suspected cause of reaction. Staff training should be improved. Application of the recommendations regarding the content and accessibility of EK and a widespread emergency action plan is needed.

Management of anaphylaxis in children: a survey of parents and school personnel in Qatar

BACKGROUND

Allergies are a growing health concern with a significant impact on quality of life and healthcare costs. It is critical to develop an appropriate care plan to deal with children's allergies. This study aimed to assess and compare the knowledge and perception of families and school personnel caring for children with history of anaphylaxis who were prescribed the epinephrine autoinjector (EpiPen). The study also examined the underlying reasons for any observed knowledge gaps.

METHODS

A cross-sectional study of 128 families and 50 corresponding school personnel caring for children at risk of anaphylaxis who had been prescribed the EpiPen was conducted. The primary outcome was to identify any knowledge deficiency within family and school personnel and the reasons behind knowledge gaps.

RESULTS

Of the 128 screened schools, 30 (23%) were not informed by parents about their pupils' risk of anaphylaxis. Importantly, 113 (88%) of families and 42 (84%) of schools were unable to recognise the symptoms of anaphylaxis. Also, 67 (52%) of families and 22 (44%) of schools were not aware that a child should ideally have two EpiPen in case of a severe allergic reaction. The EpiPen had been used by 18 (14%) families and 5 (6%) schools.

DISCUSSION

Communication among families and school personnel regarding anaphylaxis was suboptimal. Both parents and school personnel lacked key information in allergy management. Managing a child at risk of anaphylaxis requires effective communication among healthcare professionals, families and schools. There is an urgent need to improve knowledge of anaphylaxis and its management among families and school caregivers.

Clinical Management of Psychosocial Concerns Related to Food Allergy

Current estimates indicate that 4% to 8% of children in the United States are diagnosed with food allergy, and more than 40% of US children with food allergy experience severe allergic reactions. Families trying to avoid foods that may trigger an allergic reaction and ensure adequate treatment of allergic reactions that do occur face numerous challenges. The rise in the number of children diagnosed with food allergies underscores the importance of food allergy-related interventions to address elevated psychosocial concerns, such as parenting stress, anxiety, and worries about bullying. This review provides an overview of common psychosocial concerns among children with food allergy and their families across the developmental spectrum, and offers guidance to medical providers regarding the identification and treatment of food allergy-related psychosocial challenges.

Food Allergy Trends and Epinephrine Autoinjector Presence in Summer Camps

BACKGROUND

Pediatric campers with food allergies are at greater risk for exposure and anaphylaxis. A diagnosis of asthma increases risk for anaphylaxis. Epidemiological investigations of food-allergic children at high risk for allergic reactions requiring intervention in camp settings are lacking.

OBJECTIVE

The objectives of this study were to estimate the prevalence of food allergies among otherwise healthy campers in summer camps throughout the United States and Canada, and to assess asthma comorbidity and determine rates of epinephrine autoinjector prescriptions present in this population.

METHODS

We partnered with CampDoc.com, a web-based camp electronic health record system. Deidentified data were abstracted from 170 camps representing 122,424 campers. Only food allergies with a parental report of symptoms requiring intervention or with a camp prescription for an epinephrine autoinjector were included, whereas gluten, lactose intolerance, and food dyes were excluded. Asthma status and epinephrine presence on the camp medication list were assessed.

RESULTS

Overall, 2.5% of campers (n = 3055) had documented food allergies. Of these campers, 22% had multiple food allergies. Median age was 11 years; 52% were female. Nuts (81%), seafood (17.4%), egg (8.5%), fruit (8.1%), and seeds (7.2%) were the top 5 food allergies reported. Of food-allergic campers, 44.3% had concurrent asthma and 34.7% of those campers were taking multiple asthma medications. Less than half (39.7%) of food-allergic children brought an epinephrine autoinjector to the camp.

CONCLUSIONS

Life-saving epinephrine is not necessarily available for food-allergic children in camp settings. A substantial proportion of food-allergic campers are at higher risk for anaphylaxis based on concurrent asthma status.

Self-medication of anaphylactic reactions due to Hymenoptera stings-an EAACI Task Force Consensus Statement

An anaphylactic reaction due to a Hymenoptera sting is a clinical emergency, and patients, their caregivers as well as all healthcare professionals should be familiar with its recognition and acute management. This consensus report has been prepared by a European expert panel of the EAACI Interest Group of Insect Venom Hypersensitivity. It is targeted at allergists, clinical immunologists, internal medicine specialists, pediatricians, general practitioners, emergency department doctors, and any other healthcare professional involved. The aim was to report the scientific evidence on self-medication of anaphylactic reactions due to Hymenoptera stings, to inform healthcare staff about appropriate patient self-management of sting reactions, to propose indications for the prescription of an adrenaline auto-injector (AAI), and to discuss other forms of medication. First-line treatment for Hymenoptera sting anaphylaxis is intramuscular adrenaline. Prescription of AAIs is mandatory in the case of venom-allergic patients who suffer from mast cell diseases or with an elevated baseline serum tryptase level and in untreated patients with a history of a systemic reaction involving at least two different organ systems. AAI prescription should also be considered in other specific situations before, during, and after stopping venom immunotherapy.

Training and administration of epinephrine auto-injectors for anaphylaxis treatment in US schools: results from the EpiPen4Schools(®) pilot survey

BACKGROUND

Anaphylaxis is a serious, potentially life-threatening condition. Adequate preparation for anaphylaxis management is imperative for school personnel. This descriptive pilot study assessed preparedness of US schools to manage anaphylactic reactions.

METHODS

An exploratory, cross-sectional, web-based, pilot survey assessed the occurrence and characteristics of anaphylactic events, as well as training provided to school personnel for the recognition and treatment of anaphylaxis. Eligible US schools were participants in the EpiPen4Schools(®) program during the 2013-2014 school year. EpiPen4Schools provides EpiPen(®) (epinephrine injection) Auto-Injectors and training materials to qualifying US schools. Survey data were parsed by US Census Bureau region and state and were evaluated using descriptive statistics.

RESULTS

Schools from all 50 states and the District of Columbia participated in the survey (N=6,019). Among schools that provided information on anaphylactic events, 11% (607/5,683) reported the occurrence of one or more events, with significant variability in incidence across census regions and among states. A total of 5,613 schools provided information regarding which staff members were trained to recognize the signs and symptoms of anaphylaxis. Thirty-six percent of schools (2,022/5,613) indicated that only the school nurse and select staff were trained in anaphylaxis recognition. The proportion of schools in which most or all school staff received such training differed by region/state (range, 13%-100%). A total of 5,578 schools provided information on which staff were permitted to administer epinephrine. The majority of schools (54%; 3,024/5,578) permitted only the school nurse and select staff to administer epinephrine, although percentages varied by region/state (range, 4%-100%).

CONCLUSION

Schools differed substantially in their preparedness to manage anaphylaxis, with significant disparities in staff training and permission to treat. Given the ramifications of delayed treatment, removing barriers to the recognition and treatment of anaphylactic events in schools is an important public health goal.

Anaphylaxis Preparedness among Preschool Staff before and after an Educational Intervention

Introduction. Children with severe food allergies may spend many hours in the preschool setting. Little is known about anaphylaxis recognition and management preparedness among preschool staff. The objective of this study was to assess anaphylaxis preparedness among preschool staff. Methods. Anonymous questionnaires were administered before and after a 40-minute educational seminar on anaphylaxis recognition and management. Results. In total, 181 individuals participated in the preintervention survey and 171 participated in the postintervention survey. The comfort level with recognizing anaphylaxis and administering an epinephrine autoinjector significantly increased after the intervention (P < .001 for both). Of the 5 steps needed to administer an epinephrine autoinjector, staff named a mean (SD) of 3 (1.3) steps in the correct order compared with 4.2 (1.1) steps after the educational intervention (P < .001). Conclusion. This study shows that a brief education intervention can significantly increase caregiver comfort regarding identifying anaphylaxis and administering an epinephrine autoinjector.

Emergency epinephrine use for food allergy reactions in Chicago Public Schools

BACKGROUND

Given the increase in childhood food allergy, national and local policies have been developed to encourage schools to stock undesignated epinephrine auto-injectors in case of an anaphylactic emergency.

PURPOSE

To describe the use of epinephrine auto-injectors in Chicago Public Schools during the 2012-2013 school year, specifically for food-induced allergic reactions.

METHODS

District-issued epinephrine auto-injectors were distributed to all public and charter schools in Chicago prior to the start of the 2012-2013 school year. Data on their use were collected, and frequencies were computed in the autumn of 2013.

RESULTS

Thirty-eight district-issued epinephrine auto-injectors were administered during the inaugural year of the Chicago Public Schools initiative. Epinephrine auto-injectors were administered to students (92.1%) and school staff (7.9%). Most district-issued epinephrine auto-injectors were administered in elementary schools (63.2%) and on Chicago's North-Northwest Side (36.8%). More than half (55.0%) of all district-issued epinephrine auto-injectors were administered for first-time anaphylactic events. Food-induced reactions accounted for more than half (55.3%) of all reactions requiring epinephrine auto-injector use, whereas the trigger of more than one third (34.2%) of all reactions requiring the use of an epinephrine auto-injector remained unknown.

CONCLUSIONS

Chicago Public Schools is the first large, urban school district in the U.S. to develop and implement the District-Issued Emergency Epinephrine Initiative, which helped 38 students and staff avoid potential morbidity and mortality. The impact of this initiative during its first year underscores the need for stocking undesignated epinephrine in schools across the country.

Identifying barriers to chronic disease reporting in Chicago Public Schools: a mixed-methods approach

BACKGROUND

Chronic disease among school-aged children is a public health concern, particularly for asthma and food allergy. In Chicago Public Schools (CPS), rates of asthma and food allergy among students are underreported. The aim of this study was to determine the barriers to chronic disease reporting as experienced by CPS parents and school nurses.

METHODS

A mixed-methods approach included focus groups and key informant interviews with parents and school nurses, and a cross-sectional survey was completed by parents. Qualitative data analysis was performed and survey data were analyzed to determine the significant demographic and knowledge variables associated with successfully completing the reporting process.

RESULTS

The three main barriers identified were 1) a lack of parental process knowledge; 2) limited communication from schools; and 3) insufficient availability of school nurses. Parents were significantly more likely to successfully complete the reporting process if they knew about special accommodations for chronic diseases, understood the need for physician verification, and/or knew the school nurse.

CONCLUSIONS

These findings suggest that increasing parental knowledge of the reporting process will allow schools to better identify and manage their students' chronic conditions. A parent-focused intervention informed by these results has been completed.

Diagnosis and management of food allergies: new and emerging options: a systematic review

It is reported that 6% of children and 3% of adults have food allergies, with studies suggesting increased prevalence worldwide over the last few decades. Despite this, our diagnostic capabilities and techniques for managing patients with food allergies remain limited. We have conducted a systematic review of literature published within the last 5 years on the diagnosis and management of food allergies. While the gold standard for diagnosis remains the double-blind, placebo-controlled food challenge, this assessment is resource intensive and impractical in most clinical situations. In an effort to reduce the need for the double-blind, placebo-controlled food challenge, several risk-stratifying tests are employed, namely skin prick testing, measurement of serum-specific immunoglobulin E levels, component testing, and open food challenges. Management of food allergies typically involves allergen avoidance and carrying an epinephrine autoinjector. Clinical research trials of oral immunotherapy for some foods, including peanut, milk, egg, and peach, are under way. While oral immunotherapy is promising, its readiness for clinical application is controversial. In this review, we assess the latest studies published on the above diagnostic and management modalities, as well as novel strategies in the diagnosis and management of food allergy.

[Anaphylaxis: recognize and treat early]

Allergic emergencies in children are now more frequent and unpredictable and can cause death by anaphylactic shock, bronchospasm, and airway angioedema. Despite the publication of recent guidelines, many studies show that caregivers are still not at ease with the management of anaphylaxis and intramuscular administration of adrenaline. The prognosis depends on the early diagnosis of anaphylaxis and adrenaline administration before cardiorespiratory failure. The biphasic course of anaphylaxis requires systematic hospitalization of at least 6–24 hours depending on severity. To prevent recurrence, each child with anaphylaxis should permanently be in possession of two unexpired self-injectable adrenaline devices with a demonstration and written instructions on its use. Close collaboration between emergency departments, allergist, and family is essential to adapt therapeutic education and allergen avoidance to the allergen identified. This article focuses on opportunities to improve the skills of caregivers and standardize the management of anaphylaxis by proposing a practical definition and a therapeutic strategy based on Ring grading of severity.

Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization

BACKGROUND

Food-induced anaphylaxis (FIA) is potentially life threatening. Prompt administration of epinephrine is universally recommended by current treatment guidelines.

OBJECTIVE

To identify factors associated with early epinephrine treatment for FIA and to specifically examine the association between early epinephrine treatment and hospitalization.

METHODS

A chart review study conducted at Hasbro Children's Hospital/Rhode Island Hospital. By using the International Classification of Diseases, Ninth Revision codes, we identified all patients who presented to the emergency department with FIA between January 1, 2004, and December 31, 2009. Early epinephrine treatment was defined as receipt of epinephrine before arrival to the emergency department. The independent association between early epinephrine treatment and hospitalization was assessed using logistic regression.

RESULTS

Among the 384 emergency department visits for FIA identified during the study period, 234 patients received epinephrine (61%). Among this subset, most (164 [70%]) received early epinephrine treatment, whereas a smaller number of patients (70 [30%]) first received epinephrine in the emergency department (late treatment). Patients who received early epinephrine treatment were older (7.4 vs 4.3 years; P = .008), were more likely to have a known food allergy (66% vs 34%; P < .001), and were more likely to own an epinephrine autoinjector (80% vs 23%; P < .001). Patients treated early were less likely to be hospitalized (17% vs 43%; P < .001). After adjusting for age, sex, and race, the patients who received early epinephrine treatment remained at significantly decreased risk of hospitalization compared with those who received late epinephrine treatment (odds ratio 0.25 [95% CI, 0.12-0.49]).

CONCLUSIONS

In this population, early treatment of FIA with epinephrine was associated with significantly lower risk of hospitalization. Accordingly, this study supports the benefit of prompt administration of epinephrine for the treatment of FIA.

Longitudinal study of 954 patients with stinging insect anaphylaxis

BACKGROUND

Stinging insect anaphylaxis (SIA) is a common cause of anaphylaxis and is potentially life-threatening.

OBJECTIVES

To examine US patients with an emergency department (ED) visit or hospitalization for SIA to evaluate postdischarge follow-up care.

METHODS

We identified all patients with an ED visit or hospitalization for SIA during 2002-2008 in the MarketScan Database using International Classification of Diseases, Ninth Revision, Clinical Modification codes (index date was the initial ED visit or hospitalization). Patients were required to have continuous full insurance coverage for 1 year or more before and after index. We examined patient factors during the preindex period, characteristics of the index event, and outcomes during the postindex period. Multivariable logistic regression was used to identify independent predictors of receiving preventive anaphylaxis care.

RESULTS

We identified 954 patients with an ED visit or hospitalization for SIA (mean [SD] age, 46 [19] years; 41% female). A total of 85% of patients were discharged directly from the ED. For those hospitalized, the mean hospital stay was 1 day, and 50% spent time in the intensive care unit. Cardiorespiratory failure occurred in 27% of those hospitalized. During the postindex period, 69% filled 1 or more epinephrine autoinjector prescription, but only 14% had 1 or more allergist/immunologist visit. Independent factors associated with receiving preventive anaphylaxis care during the postindex period were higher household income, no ED visit (for any reason) in the preindex period, and no cardiorespiratory arrest or failure during the index event.

CONCLUSION

Although two-thirds of patients filled a prescription for an epinephrine autoinjector after an ED visit or hospitalization for SIA, only 14% of patients received follow-up care by an allergist/immunologist. This missed opportunity to provide venom immunotherapy, an essentially curative therapy, unnecessarily places patients at risk for recurrent anaphylaxis.

Update in pediatric anaphylaxis: a systematic review

Anaphylaxis is common in children and has many differences across age groups. A systematic review of the literature from the past 5 years was conducted with the goal of updating the pediatrician. Food is the most common trigger in children, but insect venom and drugs are other typical causes. Clinical diagnostic criteria include dermatological, respiratory, cardiovascular, and gastrointestinal manifestations. A biphasic reaction is seen in some, with recurrence usually within 8 hours of the initial episode. Epinephrine is the drug of choice for acute reactions and the only medication shown to be lifesaving when administered promptly, but it is underutilized. Patients should have ready access to ≥2 doses of an epinephrine autoinjector, with thorough training regarding correct use of a given device and an emergency action plan. Management of anaphylaxis in schools presents distinct challenges. Pediatricians are in a unique position to assess and treat these patients chronically.

Anaphylaxis in children: current understanding and key issues in diagnosis and treatment

Anaphylaxis is a severe allergic reaction that is rapid in onset and may cause death. Since it is unpredictable and potentially fatal, prompt recognition and treatment are vital to maximize a positive outcome. The occurrence of anaphylaxis is increasing across all ages in the United States, with increased risk of worse outcome in teenagers/young adults and in those with comorbid conditions such as asthma. Gaps in the assessment of patient-specific risk factors, identification and prevention of triggers, recognition of signs/symptoms, and pharmacologic treatment of anaphylaxis have been identified at the physician and caregiver/patient level. A PubMed literature search (January 2000–December 2011) was conducted to identify publications on childhood anaphylaxis using the following terms: food allergy, food allergens, food hypersensitivity, epinephrine, epinephrine auto-injectors, anaphylactic triggers, and anaphylaxis. This review will critically appraise these key issues and highlight strategies that might result in improved management of anaphylaxis in children.

Anaphylaxis in the pediatric patient: optimizing management and prevention

Recent reports describing a rise in serious allergies and life-threatening reactions have prompted the need for pediatric nurse practitioners to re-evaluate and hone their clinical skills with regard to the recognition of anaphylaxis. An accredited symposium entitled, "Anaphylaxis in the Pediatric Patient: Optimizing Management and Prevention" was held in conjunction with the 2012 Annual Conference of the National Association of Pediatric Nurse Practitioners. This article is an accredited enduring activity from that symposium. Goals of this activity are to (a) provide participants with information regarding current trends in serious allergies and anaphylaxis, (b) discuss recommendations from clinical guidelines designed to standardize practice, and (c) address medical and educational needs of patients with anaphylaxis. This article focuses on the point of care where pediatric nurse practitioners require the diagnostic skills to determine whether a patient's acute symptoms are consistent with a diagnosis of anaphylaxis and whether epinephrine should be used to treat those symptoms. The rationale for the use of intramuscular epinephrine, insights into the development and execution of an emergency action plan, and patient education also are discussed.