title: The use of adrenaline autoinjectors by children and teenagers.
abstract: 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.
  
  
  OBJECTIVE
  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
  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.
authors.affiliation: Biomedical Research Centre, Imperial College and Imperial College Healthcare NHS Trust, London, UK. lee.noimark@bartsandthelondon.nhs.uk
authors.forename: L
authors.initials: L
authors.lastname: Noimark
authors.forename: J
authors.initials: J
authors.lastname: Wales
authors.forename: G
authors.initials: G
authors.lastname: Du Toit
authors.forename: C
authors.initials: C
authors.lastname: Pastacaldi
authors.forename: D
authors.initials: D
authors.lastname: Haddad
authors.forename: J
authors.initials: J
authors.lastname: Gardner
authors.forename: W
authors.initials: W
authors.lastname: Hyer
authors.forename: G
authors.initials: G
authors.lastname: Vance
authors.forename: C
authors.initials: C
authors.lastname: Townshend
authors.forename: M
authors.initials: M
authors.lastname: Alfaham
authors.forename: P D
authors.initials: PD
authors.lastname: Arkwright
authors.forename: R
authors.initials: R
authors.lastname: Rao
authors.forename: S
authors.initials: S
authors.lastname: Kapoor
authors.forename: A
authors.initials: A
authors.lastname: Summerfield
authors.forename: J O
authors.initials: JO
authors.lastname: Warner
authors.forename: G
authors.initials: G
authors.lastname: Roberts
mesh_terms: D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D000707:Anaphylaxis / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000295:instrumentation / Q000379:methods; D008297:Male; D011446:Prospective Studies; D006113:United Kingdom
chemical_list: D000316:Adrenergic alpha-Agonists; D004837:Epinephrine