Product information and disease description Place of product in therapy Approaches to treatment

Care management intervention strategies

11 evidence topics · 3 sources

Written anaphylaxis emergency action plans

“In addition, it is recommended that they always carry a personalized written anaphylaxis emergency action plan that illustrates how to recognize anaphylaxis symptoms (eg, tingling in the extremities, sense of heat, sense of dizziness/fainting, swollen lips-tongue-uvula, shortness of breath, wheeze, stridor, collapse) and instruct them to inject epinephrine rapidly, via the intramuscular route, in the mid-anterolateral thigh, holding the EAI in place for about 3–10 s and then to call for medical assistance.” (opens the source at this quote in a new tab)
“At the time of discharge from a health care setting, patients, at risk of another episode of anaphylaxis, should be prescribed and taught about self-administration of epinephrine (adrenaline), and have a written personalized anaphylaxis emergency action plan and medical identification method.” (opens the source at this quote in a new tab)

Patient and caregiver education and device training

“During visits with patients who have been prescribed EAIs, we recommend that clinicians routinely review the essentials of EAI carriage, storage, and use; encourage patients to regularly practice EAI administration with a trainer device; and discuss strategies to manage barriers to adherence that patients may have experienced.” (opens the source at this quote in a new tab)
“Multiple studies reveal the benefits of clinician-provided education and counseling for improving EAI-related knowledge, skills, and comfort.” (opens the source at this quote in a new tab)

Stock epinephrine and staff training in schools and childcare centers

“We suggest childcare centers and schools implement staff training for allergy and anaphylaxis management.” (opens the source at this quote in a new tab)
“We suggest that childcare centers and schools stock undesignated EAIs that can be used to treat any individual on school grounds who experiences anaphylaxis.” (opens the source at this quote in a new tab)
“Across studies, the median reported rate of anaphylaxis in childcare centers or schools was 19 per 100,000 students per year (range: 8-118/100,000).” (opens the source at this quote in a new tab)

State laws governing stock epinephrine in schools

“All 50 states and DC allow undesignated epinephrine in schools to use for allergic or anaphylactic reactions. A key difference arises in whether states allow (N=37) or mandate (N=14) that schools stock epinephrine.” (opens the source at this quote in a new tab)
“This review of stock epinephrine laws and policies highlights the significant variation in state legislation despite widespread adoption. Only one-quarter of states mandate that schools have stock epinephrine available for emergency use, underscoring need for a more unified approach with consistent guidelines, comprehensive training, and possible funding for implementation.” (opens the source at this quote in a new tab)

Dosage form specified by school stock epinephrine laws

“In addition, most states (N=45) require auto-injectable epinephrine to be available at school. One state requires pre-filled syringes (Missouri). Five states do not specify the dispense method for stock epinephrine.” (opens the source at this quote in a new tab)
“Twenty-nine states indicate students can administer stock epinephrine themselves.” (opens the source at this quote in a new tab)

School action plans and administration documentation

“Twenty-five states require schools have anaphylaxis action plans or protocols. Nineteen states require schools to document when stock epinephrine was administered.” (opens the source at this quote in a new tab)

Stock epinephrine in other community settings

“We suggest that keeping stock EAI in community settings be encouraged, if feasible.” (opens the source at this quote in a new tab)
“Although permitted, it is rare for community settings to have stock epinephrine available. There is a lack of data on the health effects, feasibility, and cost-effectiveness of stocking epinephrine in community settings outside of schools.” (opens the source at this quote in a new tab)

Emergency medical services activation after epinephrine use

“We suggest that clinicians counsel patients that immediate activation of EMS may not be required if the patient experiences prompt, complete, and durable response to treatment with epinephrine, provided that additional epinephrine and medical care are readily available, if needed. We suggest that clinicians counsel patients to always activate EMS after epinephrine use if anaphylaxis is severe, fails to resolve promptly, fails to resolve completely or nearly completely, or returns or worsens after a first dose of epinephrine.” (opens the source at this quote in a new tab)

Immediate steps taken during an episode

“Therefore, when a patient has anaphylaxis it is important to follow the steps outlined (Fig. 4): remove exposure to the trigger if possible (eg, discontinue administration of drugs/therapeutic agents), assess airways, breathing, circulation, mental status, and skin, and simultaneously call emergency services, injecting epinephrine (adrenaline) intramuscularly into the vastus lateralis of the quadriceps (antero-lateral thigh), and positioning the patient according to his/her presenting features.” (opens the source at this quote in a new tab)

Referral pathway and follow-up after an episode

“Most cases of anaphylaxis are first seen by emergency doctors or general practitioners, but only 50% are referred to a specialist for further investigation and/or treatment. Provision of advice relating to trigger avoidance and emergency protocols, at the time of discharge from the emergency room, are practically nonexistent, according to the international survey.” (opens the source at this quote in a new tab)
“One of the major concerns is the underuse of epinephrine self-infectors by patients who experience anaphylaxis recurrences, despite having the medication.” (opens the source at this quote in a new tab)

Number of devices prescribed and refill considerations

“We suggest that they routinely prescribe more than 1 EAI when patients have previously required multiple doses of epinephrine to treat an episode of anaphylaxis and/or have a history of biphasic reactions.” (opens the source at this quote in a new tab)
“To manage the potential risk of anaphylaxis requiring more than 1 dose of epinephrine, regulatory agencies including the FDA have recommended that patients at risk of anaphylaxis carry 2 EAIs at all times.” (opens the source at this quote in a new tab)