Prescription of adrenaline auto-injectors for potential anaphylaxis—a population survey

doi:10.1016/S0033-3506(03)00034-9

Public Health

Volume 117, Issue 4, July 2003, Pages 256-259

https://doi.org/10.1016/S0033-3506(03)00034-9 Get rights and content

Abstract

Objective. To assess the quality of training provided to parents of children prescribed adrenaline auto-injector devices, adherence to the Chief Medical Officer's recommendation regarding specialist referral, and effect of allergies on quality of life.

Setting. Middlesbrough, Redcar and Cleveland districts in North-east England.

Design. Postal questionnaire to parents of all children prescribed an auto-injector in the area (n=154).

Results. One hundred and seven parents replied. General practitioners were the source of initial prescription for 30 children. Fifty-one children were not referred to a specialist allergy clinic. Four parents said that they had received no training in the use of the device. Dummy auto-injectors were not used to train 51 parents. Forty-six families were not given the opportunity to retrain. Eleven parents had low or very low confidence in the use of the device, and 13 parents were unsure when to use it. Quality of life was significantly affected. Sixteen children were bullied as a result of their allergy. Thirty parents felt that their child could not do something they really enjoyed as a result of the allergy, and 39 parents felt that their own lifestyle was affected.

Conclusion. The impact of the prescription of auto-injector devices should not be underestimated. National guidelines regarding specialist referral were often not followed, and this needs to be addressed by primary care organizations. Quality of training issues needed to be addressed and this has led to re-organization of services in our district.

Introduction

Food allergies can cause severe and potentially fatal anaphylactic reactions.1., 2. Early administration of adrenaline may reduce the risk of death from anaphylaxis due to food allergy, yet evidence-based data on the management of children with food allergies are lacking and it can often be difficult to decide which children should be provided with adrenaline syringes.2., 3., 4. The presence of allergies and prescription of these devices has significant implications for children and their families. In 1998, the Department of Health issued guidelines recommending referral of all children with suspected peanut allergy to a specialist centre for diagnosis.⁵

Once devices are prescribed, carers and education staff need to be trained in the use of these devices—a task which is often done unsatisfactorily.6., 7., 8. Most of our local schools now have at least one child prescribed with an auto-injector device, and some schools have as many as six such children.⁹ Over the last 5 years, the community child health services in our district have provided a centrally co-ordinated programme of training and refresher courses for the parents and school staff of children who had been prescribed auto-injectors. Despite this, there was anecdotal evidence of variation in prescribing practice and problems with training. As a result, it was decided to undertake a survey with the following aims:

1.
To determine local prescription practices of adrenaline auto-injectors and adherence to the Chief Medical Officer's recommendations regarding referral to specialist clinics in our population.
2.
To assess quality of training provided to parents on the use of these devices.
3.
To assess the impact of allergies and the need to carry an auto-injector on the quality of life of these families.

Section snippets

Setting and study population

The local authority areas served by our department are Middlesbrough, Redcar and Cleveland, which are in the quintile of the most deprived in the country. There are about 48 000 school-aged children in the area and 146 schools. Each school has a named school nurse and community paediatrician. Referral of most children with potential anaphylactic reactions takes place from general practitioners (GPs) to local consultant paediatricians. The GPs and consultant paediatricians refer some children to

Results

One-hundred and forty questionnaires were sent out and 107 responses were obtained (76% ; see Table 1). Thirty (28%) children had the device prescribed initially by their GP, 56 (52.3%) by a paediatrician and 21 (19.7%) by an immunologist. Fifty-one children (47.6%) had not been seen by an immunologist or in an allergy clinic, contrary to the Chief Medical Officer's guidelines.

Regarding the quality of training issues, surprisingly five parents (4.6%) said that they had not received any formal

Discussion

Although some controversy exists regarding which children should be prescribed adrenaline auto-injectors,3., 4. and their efficacy in prevention of fatalities has not been firmly established, it is clearly important to train families well in their use if they are to be of any benefit. Adrenaline is a potent drug and its inappropriate use should be avoided in view of potential serious side-effects. There have been concerns raised that adrenaline syringes are vastly overprescribed. The Chief

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Citation Excerpt :
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Peanut allergy accounts for most severe food-related allergic reactions, and accidental exposures are frequent. Delayed administration of epinephrine and the allergic individual's failure to personally carry epinephrine contribute to fatal outcomes.
To describe epinephrine autoinjector availability at school and to determine factors that might affect autoinjector availability in children allergic to peanut.
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Almost 50% of children allergic to peanut might experience a delay in anaphylaxis treatment due to limited access to their device. More education is required regarding the importance of a readily available autoinjector.
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