The use of adrenaline autoinjectors by children and teenagers.

BACKGROUND: Although adrenaline is recommended as first line treatment for anaphylaxis, it is often not utilized. There has been a debate about when adrenaline autoinjectors should be prescribed and how many should be dispensed. OBJECTIVES: To see how many adrenaline autoinjectors were used during anaphylactic reactions and to determine why they were not used in situations where they were clinically indicated. METHODS: Patients were recruited prospectively at 14 paediatric allergy clinics throughout UK. Participants completed a questionnaire covering demographic data, atopic status and details of allergic reactions in the previous year and reasons for using more than one device. RESULTS: A total of 969 patients were recruited of whom 466 (48.1%, 95% CI: 37.9-58.2) had had at least one reaction in the previous year; 245 (25.3%, 95% CI: 16.2-34.4) of these reactions were anaphylaxis. An adrenaline autoinjector was used by 41 (16.7%, 95% CI: 11.7-21.3) participants experiencing anaphylaxis. Thirteen participants received more than one dose of adrenaline, for nine of these a health professional gave at least one. The commonest reasons for using more than one were severe breathing difficulties (40%), lack of improvement with first dose (20%) and miss-firing (13.3%). The commonest reasons for not using adrenaline in anaphylaxis were 'thought adrenaline unnecessary' (54.4%) and 'unsure adrenaline necessary' (19.1%). Many with wheeze did not use their autoinjector. CONCLUSIONS AND CLINICAL RELEVANCE: Adrenaline is used by only a minority of patients experiencing anaphylaxis in the community. Thirteen of the 41 patients with anaphylaxis who used their autoinjector needed another dose of adrenaline. Further research is needed to consider how to best encourage the usage of adrenaline when clinically indicated in anaphylaxis.

Parents' attitudes when purchasing products for children with nut allergy: a UK perspective.

Food avoidance remains the main strategy in prevention of anaphylaxis in children with acute food allergies. To achieve this aim, product labelling needs to be clear and accurate and parents educated on optimal avoidance measures. Food product labelling although improved often still remains ambiguous. The aim of this study was to understand and quantify the attitudes of parents of children with nut allergy towards labels informing that the product could contain nuts. An anonymous questionnaire was filled out by parents of children with nut allergy attending a tertiary paediatric allergy clinic to assess response to differing descriptive labelling of foods containing nuts. In 184 questionnaire responses, 80% of parents would not purchase a product labelled 'not suitable for nut allergy sufferers' or 'may contain nuts'. However, other labels including 'this product does not contain any nuts but is made in a factory that uses nuts', 'cannot guarantee is nut free' and 'may contain traces of nuts' were avoided by only around 50% of parents. Previous allergic reaction to nut products had no bearing on outcome. Additionally, large numbers of parents did not read labels for the presence of nuts in non-food products. A large number of patients with nut allergy continue risk-taking by either ignoring warning labels on foods or assuming that there is a gradation of risk depending on the wording of label warnings. Further tightening of labelling legislation and improved education would help to decrease the risk of anaphylaxis.

Transposition of the great arteries, ventricular septal defect and diaphragmatic hernia in a fetus: the role of prenatal diagnosis in helping to predict postnatal survival.

Congenital heart disease and congenital diaphragmatic hernia are frequently associated. The combination of these lesions is predictive of poor postnatal survival. The identification of both lesions during prenatal life may facilitate improved survival in carefully selected cases. We present a case of left-sided diaphragmatic hernia with transposition of the great arteries and a ventricular septal defect (VSD) that survived following repair of both defects within the first six weeks of life.