ABSTRACT
Anaphylaxis is a hypersensitivity reaction that is rapid in onset, multi-system involved and can be fatal.Adrenaline is the first-line treatment of anaphylaxis.Adrenaline autoinjector is an important device in emergent situation.In European Academy of Allergy and Clinical Immunology anaphylaxis guideline updated in 2021, adrenaline autoinjector is systemically described and recommended.The following interpretation is focused on adrenaline autoinjector, including advantages, indications for prescription, pharmacokinetic data, dose and long-term management, aimed to enhance understanding of this device and standardize future application.
ABSTRACT
A anafilaxia é uma reação alérgica potencialmente fatal. Autoinjetor pode ser prescrito para tratamento precoce nesses casos. Relatamos o caso de uma criança que fez uso acidental de adrenalina autoinjetora que ao exame de imagem evidenciou falange distal com fratura. Objetivamos alertar a importância de orientar o paciente e seus familiares acerca do uso correto desse dispositivo.
Anaphylaxis is a potentially fatal allergic reaction. Autoinjection can be prescribed for early treatment in these cases. We report the case of a child who accidentally used an adrenaline autoinjector and then had a distal phalanx fracture on imaging examination. We aim to draw attention to the importance of carefully guiding patients and their families about the correct use of this device.
Subject(s)
Humans , Male , Child , Epinephrine , Epinephrine/adverse effects , Equipment and Supplies , Anaphylaxis , Therapeutics , Accidents , Family , Fractures, Bone , HypersensitivityABSTRACT
BACKGROUND: In view of the increasing prevalence of food allergies, there has been an associated increase in frequency of situations requiring an emergency response for anaphylaxis at the home, childcare facilities and educational institutions. OBJECTIVE: To clarify the situation of adrenaline auto-injector administration in nursery/kindergarten/school, we carried out a questionnaire survey on pediatric physicians in Western Japan. METHODS: In 2015, self-reported questionnaires were mailed to 421 physicians who are members of the West Japan Research Society Pediatric Clinical Allergy and Shikoku Research Society Pediatric Clinical Allergy. RESULTS: The response rate was 44% (185 physicians) where 160 physicians had a prescription registration for the adrenaline auto-injector. In the past year, 1,330 patients were prescribed the adrenaline auto-injector where 83 patients (6% of the prescribed patients) actually administered the adrenaline auto-injector, of which 14 patients (17% of the administered patients) self-administered the adrenaline auto-injector. “Guardians” at the nursery/kindergarten and elementary school were found to have administered the adrenaline auto-injector the most. Among 117 adrenaline auto-injector prescription-registered physicians, 79% had experienced nonadministration of adrenaline auto-injector at nursery/kindergarten/school when anaphylaxis has occurred. The most frequent reason cited for not administering the adrenaline auto-injector was “hesitation about the timing of administration.” CONCLUSION: If the adrenaline auto-injector was administered after the guardian arrived at the nursery/kindergarten/school, it may lead to delayed treatment of anaphylaxis in which symptoms develop in minutes. Education and cooperation among physicians and nursery/kindergarten/school staff will reduce the number of children suffering unfortunate outcomes due to anaphylaxis.
Subject(s)
Child , Humans , Anaphylaxis , Education , Emergencies , Epinephrine , Food Hypersensitivity , Hypersensitivity , Japan , Nurseries, Infant , Postal Service , Prescriptions , PrevalenceABSTRACT
Objective: The objective was to compare the biochemical changes of amikacin by autoinjector delivery and manual injection in rats. Materials and Methods: Amikacin drug cartridge (500 mg/2 mL) for autoinjectors was diluted to 63 mg/mL and rats were administered 1.2 mL, i.p. One group was given 3 and a second group 7 injection on consecutive days. 3 and 7 days manual injection of same dose of amikacin (about 500 mg/kg, i.p.) and a control group (saline) were also included (total 5 groups). On day 4 or 8 biochemical parameters were studied. Results: Significant increase in urea, creatinine and aspartate aminotransferase were observed in 7 days administration in both autoinjector and manual injection groups compared to control group. All other parameters viz., glucose, cholesterol, total triglycerides, bilirubin, uric acid, total protein, albumin, alanine aminotransferase and alkaline phosphatase did not show any significant change. No significant change was observed in 3 days administration groups. Conclusion: High dose of amikacin for longer duration is known for its nephrotoxicity which is evidenced by the increase in urea and creatinine in both autoinjector and manual injection groups. This study shows that autoinjector device for amikacin which is new can be considered for further research work.
ABSTRACT
Auto-injector, a spring-driven drug-device based combination production that automatically injects the drug into the skin via a pre-filled syringe or cartridge, allows minimally trained individuals to self-inject potentially life-saving medication when e-mergency medical care may be absent or remote, and thus has been becoming a supporting approach of emergency medicine for the first-aid. The auto-injector was developed originally by the United State of America, and experienced the three outstanding states in-cluding syrettes, single chamber auto-injectors and dual chamber auto-injectors from the battlefield to the civilianization. The current auto-injector devices have five different types named as ACE (AtroPen), ComboPen, Binaject, Soluject and Truject, respectively. The applied drugs to the systems for military use have atropine, pralidoxime chloride, obidoxime, diazepam and morphine sulfate. The oth-er drugs for emergency medical use such as epinephrine, lidocaine hydrochloride and sumatriptan have been also applied to. All of the auto-injector based combination production have been twined with a simulator in order to conduct a training schedule before use. Importantly, the needle hidden or the device-status notification technique after injection has been becoming a trend in the technology advances of the auto-injectors.
ABSTRACT
Auto-injector, a spring-driven drug-device based combination production that automatically injects the drug into the skin via a pre-filled syringe or cartridge, allows minimally trained individuals to self-inject potentially life-saving medication when emergency medical care may be absent or remote, and thus has been becoming a supporting approach of emergency medicine for the first-aid. The auto-injector was developed originally by the United State of America, and experienced the three outstanding states including syrettes, single chamber auto-injectors and dual chamber auto-injectors from the battlefield to the civilianization. The current auto-injector devices have five different types named as ACE (AtroPen), ComboPen, Binaject, Soluject and Truject, respectively. The applied drugs to the systems for military use have atropine, pralidoxime chloride, obidoxime, diazepam and morphine sulfate. The other drugs for emergency medical use such as epinephrine, lidocaine hydrochloride and sumatriptan have been also applied to. All of the auto-injector based combination production have been twined with a simulator in order to conduct a training schedule before use. Importantly, the needle hidden or the device-status notification technique after injection has been becoming a trend in the technology advances of the auto-injectors.
ABSTRACT
@#BACKGROUND: Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers. The study aimed to evaluate how emergency departments (EDs) in the United States (US) manage anaphylaxis in relation to guideline recommendations. METHODS: This was an online anonymous survey of a random sample of EM health providers in US EDs. RESULTS: Data analysis included 207 EM providers. For respondent EDs, approximately 9%reported using agreed-upon clinical criteria to diagnose anaphylaxis; 42% reported administering epinephrine in the ED for most anaphylaxis episodes; and <50% provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge. Most provided some written materials, and follow-up with a primary care clinician was recommended. CONCLUSIONS: This is the first cross-sectional survey to provide "real-world" data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and fol ow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine. Prospective research is recommended.