The Experts below are selected from a list of 249 Experts worldwide ranked by ideXlab platform
Carlos A Camargo - One of the best experts on this subject based on the ideXlab platform.
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guiding principles for the recognition diagnosis and management of infants with anaphylaxis an expert panel consensus
The Journal of Allergy and Clinical Immunology: In Practice, 2019Co-Authors: Matthew Greenhawt, Estelle F R Simons, Carlos A Camargo, Michael Pistiner, R Gupta, Allen J Meadows, Jonathan M Spergel, Philip LiebermanAbstract:Infant anaphylaxis is an emerging risk, with food allergy the most common cause. Although the presentation of anaphylaxis involves the same systems as in older children and adults, there are real-world challenges to identifying symptoms of an allergic emergency in nonverbal children, as well as implementing optimal treatment. Recognition of anaphylaxis in infants can be challenging because allergic symptoms and certain normal infant behaviors may overlap. Intramuscular Epinephrine is the treatment of choice for infants, as it is for older children and adults, and an Epinephrine Autoinjector approved by the Food and Drug Administration is now available for infants weighing between 7.5 and 15 kg. A panel of experts sought to develop guiding principles for the recognition, diagnosis, and management of anaphylaxis in infants, and provide a framework for the development of new guidelines and future research. Accordingly, anaphylaxis emergency action planning for infants was addressed by the panel. In considering formation of future infant anaphylaxis guidelines, health care providers should be aware of the needs to improve the recognition, diagnosis, and management of infants with anaphylaxis. Future research should identify and validate clinical criteria for the diagnosis of anaphylaxis in infants, as well as risk factors for the most severe reactions.
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risk factors for severe anaphylaxis in patients receiving anaphylaxis treatment in us emergency departments and hospitals
The Journal of Allergy and Clinical Immunology, 2014Co-Authors: Sunday Clark, Wenhui Wei, Susan A Rudders, Carlos A CamargoAbstract:Background Although reported risk factors for severe anaphylaxis include older age, presence of comorbid medical conditions, and concomitant medications, previous studies have used varying definitions for anaphylaxis and heterogeneous methodology. Objective To describe risk factors for severe anaphylaxis among US patients treated in emergency departments (EDs) or hospitals for anaphylaxis. Methods Individuals with an ED visit/hospitalization for anaphylaxis were identified from 2 MarketScan Research Databases using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. Eligibility for the current study required continuous medical and prescription coverage for at least 1 year before and after the index date. Severe anaphylaxis was defined as a reaction requiring hospital admission. Results Among 11,972 individuals, 2,622 (22%) had severe anaphylaxis. Unadjusted analysis showed that severe anaphylaxis was associated with older age and higher comorbidity burden. These patients were also less likely to have filled an Epinephrine Autoinjector (EAI) prescription or visited an allergist/immunologist, but more likely to have had an ED visit/hospitalization (any cause). On multivariable analysis, filling an EAI prescription (odds ratio [OR], 0.64; 95% CI, 0.53-0.78) or visiting an allergist/immunologist (OR, 0.78; 95% CI, 0.63-0.95) before the index event was associated with a lower risk of severe anaphylaxis, while any previous ED visit (OR, 1.18; 95% CI, 1.07-1.30) or hospitalization (OR, 1.55; 95% CI, 1.36-1.75) was associated with a higher risk of severe anaphylaxis. Conclusions In this large cohort with an ED visit or hospitalization for anaphylaxis, 22% had severe anaphylaxis. Pre-index preventive anaphylaxis care (ie, EAI prescription fill and allergist/immunologist visit) was associated with a significantly lower risk, supporting the benefits of preventive anaphylaxis care in real-world practice.
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regional variation in Epinephrine Autoinjector prescriptions in australia more evidence for the vitamin d anaphylaxis hypothesis
Annals of Allergy Asthma & Immunology, 2009Co-Authors: Sunday Clark, Raymond J Mullins, Carlos A CamargoAbstract:Background There is little information on the regional distribution of anaphylaxis in Australia. Objective To examine the influence of latitude (a marker of sunlight/vitamin D status) as a contributor to anaphylaxis in Australia, with a focus on children from birth to the age of 4 years. Methods Epinephrine Autoinjector (EpiPen) prescriptions (2006-2007) in 59 statistical divisions and anaphylaxis hospital admission rates (2002-2007) in 10 regions were used as surrogate markers of anaphylaxis. Results EpiPen prescription rates (per 100,000 population per year) were higher in children from birth to the age of 4 years (mean, 951) than in the overall population (mean, 324). In an unadjusted model of children from birth to the age of 4 years, decreasing absolute latitude was associated with a decrease in EpiPen prescription rates, such that rates were higher in southern compared with northern regions of Australia (β, −44.4; 95% confidence interval, −57.0 to −31.8; P P Conclusions EpiPen prescription rates and anaphylaxis admissions are more common in southern regions of Australia. These data provide additional support for a possible role of vitamin D in the pathogenesis of anaphylaxis.
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anaphylaxis in the community learning from the survivors
The Journal of Allergy and Clinical Immunology, 2009Co-Authors: Estelle F R Simons, Sunday Clark, Carlos A CamargoAbstract:Background Most studies of anaphylaxis in the community focus on persons at risk who might, or might not, have experienced anaphylaxis. Objective We sought to focus on survivors of anaphylaxis in the community and their experiences in using, or not using, an Epinephrine Autoinjector for first-aid treatment. Methods An e-mail survey was conducted. Responses were anonymous and could not be traced to any person or location. Anaphylaxis was defined as the most severe sudden-onset allergic reaction ever experienced by the participants or a person for whom they were responsible (eg, a child). There were 17 core multiple-choice questions for all participants, with 16 additional questions for users who injected Epinephrine either into themselves or someone else, and 1 additional question for nonusers. Results Of the 1885 participants, 500 (27%) were Epinephrine users, and 1385 (73%) were nonusers. The groups were similar with regard to multisystem organ involvement (82% vs 78%, P = .07) and many other aspects of anaphylaxis; however, Epinephrine users were more likely (all P 1 -antihistamine (38%), no prescription for Epinephrine (28%), and/or a mild anaphylaxis episode (13%). Conclusions In a unique population composed of 1885 survivors of anaphylaxis in the community, users of Epinephrine Autoinjectors for first-aid treatment were outnumbered by nonusers. The insights reported by Epinephrine users and the reasons why nonusers did not inject Epinephrine are documented.
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anaphylaxis in the community learning from the survivors
The Journal of Allergy and Clinical Immunology, 2009Co-Authors: Estelle F R Simons, Sunday Clark, Carlos A CamargoAbstract:Background Most studies of anaphylaxis in the community focus on persons at risk who might, or might not, have experienced anaphylaxis. Objective We sought to focus on survivors of anaphylaxis in the community and their experiences in using, or not using, an Epinephrine Autoinjector for first-aid treatment. Methods An e-mail survey was conducted. Responses were anonymous and could not be traced to any person or location. Anaphylaxis was defined as the most severe sudden-onset allergic reaction ever experienced by the participants or a person for whom they were responsible (eg, a child). There were 17 core multiple-choice questions for all participants, with 16 additional questions for users who injected Epinephrine either into themselves or someone else, and 1 additional question for nonusers. Results Of the 1885 participants, 500 (27%) were Epinephrine users, and 1385 (73%) were nonusers. The groups were similar with regard to multisystem organ involvement (82% vs 78%, P = .07) and many other aspects of anaphylaxis; however, Epinephrine users were more likely (all P Conclusions In a unique population composed of 1885 survivors of anaphylaxis in the community, users of Epinephrine Autoinjectors for first-aid treatment were outnumbered by nonusers. The insights reported by Epinephrine users and the reasons why nonusers did not inject Epinephrine are documented.
Estelle F R Simons - One of the best experts on this subject based on the ideXlab platform.
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guiding principles for the recognition diagnosis and management of infants with anaphylaxis an expert panel consensus
The Journal of Allergy and Clinical Immunology: In Practice, 2019Co-Authors: Matthew Greenhawt, Estelle F R Simons, Carlos A Camargo, Michael Pistiner, R Gupta, Allen J Meadows, Jonathan M Spergel, Philip LiebermanAbstract:Infant anaphylaxis is an emerging risk, with food allergy the most common cause. Although the presentation of anaphylaxis involves the same systems as in older children and adults, there are real-world challenges to identifying symptoms of an allergic emergency in nonverbal children, as well as implementing optimal treatment. Recognition of anaphylaxis in infants can be challenging because allergic symptoms and certain normal infant behaviors may overlap. Intramuscular Epinephrine is the treatment of choice for infants, as it is for older children and adults, and an Epinephrine Autoinjector approved by the Food and Drug Administration is now available for infants weighing between 7.5 and 15 kg. A panel of experts sought to develop guiding principles for the recognition, diagnosis, and management of anaphylaxis in infants, and provide a framework for the development of new guidelines and future research. Accordingly, anaphylaxis emergency action planning for infants was addressed by the panel. In considering formation of future infant anaphylaxis guidelines, health care providers should be aware of the needs to improve the recognition, diagnosis, and management of infants with anaphylaxis. Future research should identify and validate clinical criteria for the diagnosis of anaphylaxis in infants, as well as risk factors for the most severe reactions.
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adherence with Epinephrine Autoinjector prescriptions in primary care
Allergy Asthma & Clinical Immunology, 2017Co-Authors: Elissa M Abrams, Alexander Singer, Lisa M Lix, Alan Katz, Marina Yogendran, Estelle F R SimonsAbstract:The aim of this study was to estimate primary adherence for Epinephrine Autoinjector (EA) prescriptions in primary care practices in Manitoba, Canada. A retrospective analysis of electronic medical record and administrative data was performed to determine primary adherence, defined as dispensation of a new EA prescription within 90 days of the date the prescription was written. Multivariable logistic regression models were used to test predictors of filling an EA prescription. Of 1212 EA prescriptions written between 2012 and 2014, only 69.9% (N = 847) were filled. An increased number of prescriptions for non-EA mediations was associated with an increased odds ratio of not filling an EA prescription. This is the first study in Canada to examine adherence for EA prescriptions. The non-adherence rate identified is higher than rates previously reported in the literature, and indicates that many EA prescriptions for adults seen in primary care may never be filled. It also suggests that prescriptions of EAs for all patients at risk of anaphylaxis in community settings should consistently be accompanied by concise information about the importance of having the EA prescription filled and having the EA readily available.
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Adherence with Epinephrine Autoinjector prescriptions in primary care
'Springer Science and Business Media LLC', 2017Co-Authors: Elissa M Abrams, Lisa M Lix, Alan Katz, Marina Yogendran, Alexander G. Singer, Estelle F R SimonsAbstract:Abstract Background The aim of this study was to estimate primary adherence for Epinephrine Autoinjector (EA) prescriptions in primary care practices in Manitoba, Canada. Methods A retrospective analysis of electronic medical record and administrative data was performed to determine primary adherence, defined as dispensation of a new EA prescription within 90 days of the date the prescription was written. Multivariable logistic regression models were used to test predictors of filling an EA prescription. Results Of 1212 EA prescriptions written between 2012 and 2014, only 69.9% (N = 847) were filled. An increased number of prescriptions for non-EA mediations was associated with an increased odds ratio of not filling an EA prescription. Interpretation This is the first study in Canada to examine adherence for EA prescriptions. The non-adherence rate identified is higher than rates previously reported in the literature, and indicates that many EA prescriptions for adults seen in primary care may never be filled. It also suggests that prescriptions of EAs for all patients at risk of anaphylaxis in community settings should consistently be accompanied by concise information about the importance of having the EA prescription filled and having the EA readily available
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anaphylaxis in the community learning from the survivors
The Journal of Allergy and Clinical Immunology, 2009Co-Authors: Estelle F R Simons, Sunday Clark, Carlos A CamargoAbstract:Background Most studies of anaphylaxis in the community focus on persons at risk who might, or might not, have experienced anaphylaxis. Objective We sought to focus on survivors of anaphylaxis in the community and their experiences in using, or not using, an Epinephrine Autoinjector for first-aid treatment. Methods An e-mail survey was conducted. Responses were anonymous and could not be traced to any person or location. Anaphylaxis was defined as the most severe sudden-onset allergic reaction ever experienced by the participants or a person for whom they were responsible (eg, a child). There were 17 core multiple-choice questions for all participants, with 16 additional questions for users who injected Epinephrine either into themselves or someone else, and 1 additional question for nonusers. Results Of the 1885 participants, 500 (27%) were Epinephrine users, and 1385 (73%) were nonusers. The groups were similar with regard to multisystem organ involvement (82% vs 78%, P = .07) and many other aspects of anaphylaxis; however, Epinephrine users were more likely (all P 1 -antihistamine (38%), no prescription for Epinephrine (28%), and/or a mild anaphylaxis episode (13%). Conclusions In a unique population composed of 1885 survivors of anaphylaxis in the community, users of Epinephrine Autoinjectors for first-aid treatment were outnumbered by nonusers. The insights reported by Epinephrine users and the reasons why nonusers did not inject Epinephrine are documented.
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anaphylaxis in the community learning from the survivors
The Journal of Allergy and Clinical Immunology, 2009Co-Authors: Estelle F R Simons, Sunday Clark, Carlos A CamargoAbstract:Background Most studies of anaphylaxis in the community focus on persons at risk who might, or might not, have experienced anaphylaxis. Objective We sought to focus on survivors of anaphylaxis in the community and their experiences in using, or not using, an Epinephrine Autoinjector for first-aid treatment. Methods An e-mail survey was conducted. Responses were anonymous and could not be traced to any person or location. Anaphylaxis was defined as the most severe sudden-onset allergic reaction ever experienced by the participants or a person for whom they were responsible (eg, a child). There were 17 core multiple-choice questions for all participants, with 16 additional questions for users who injected Epinephrine either into themselves or someone else, and 1 additional question for nonusers. Results Of the 1885 participants, 500 (27%) were Epinephrine users, and 1385 (73%) were nonusers. The groups were similar with regard to multisystem organ involvement (82% vs 78%, P = .07) and many other aspects of anaphylaxis; however, Epinephrine users were more likely (all P Conclusions In a unique population composed of 1885 survivors of anaphylaxis in the community, users of Epinephrine Autoinjectors for first-aid treatment were outnumbered by nonusers. The insights reported by Epinephrine users and the reasons why nonusers did not inject Epinephrine are documented.
Matthew Greenhawt - One of the best experts on this subject based on the ideXlab platform.
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health and economic outcomes of home maintenance allergen immunotherapy in select patients with high health literacy during the covid 19 pandemic a cost effectiveness analysis during exceptional times
The Journal of Allergy and Clinical Immunology: In Practice, 2020Co-Authors: Marcus Shaker, Giselle Mosnaim, John Oppenheimer, David R Stukus, Elissa M Abrams, Matthew GreenhawtAbstract:Background Allergen immunotherapy (AIT) is safe and effective but is typically administered under strict clinic observation to mitigate the risk of a systemic reaction to immunotherapy (SRIT). However, in the setting of the global coronavirus disease 2019 pandemic, alternative care models should be explored. Objective To evaluate the cost-effectiveness of home immunotherapy self-administration (HITSA) in a highly idealized circumstance for provision of maintenance AIT in a shelter-in-place or other scenarios of unforeseen reduction in nonessential medical services. Methods Markov modeling was used to compare in-office clinic AIT in selected patients using cohort analysis and microsimulation from the societal and health care perspectives. Results Assuming similar SRIT rates, HITSA was found to be a cost-effective option with an incremental cost-effectiveness ratio of $44,554/quality-adjusted life-year when considering both incremental Epinephrine Autoinjector costs and coronavirus disease 2019 risks. Excluding Epinephrine Autoinjector costs, HISTA dominated other options. However, outside of pandemic considerations, HITSA was not cost-effective (incremental cost-effectiveness ratio, $198,877,286) at annual Epinephrine Autoinjector costs above $287. As the incremental HITSA SRIT rate increased above 15%, clinic AIT was the most cost-effective strategy. Excluding both pandemic risks and risk of motor vehicle accident fatality from round-trip clinic transit, clinic AIT dominated other strategies. Clinic AIT was the more cost-effective option at very high fatality relative risk for HITSA or at very low annual risk of contracting coronavirus disease 2019. Conclusions Under idealized assumptions HITSA can be a safe and cost-effective option during a global pandemic in appropriately selected patients provided home rates of SRIT remain stable.
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the cost effectiveness of requiring universal vs contextual self injectable Epinephrine Autoinjector for allergen immunotherapy
Annals of Allergy Asthma & Immunology, 2019Co-Authors: Di Sun, Marcus Shaker, Joseph Cafone, Matthew GreenhawtAbstract:Abstract Background Aeroallergen immunotherapy (AIT) is a safe and effective disease-modifying treatment associated with rare therapy-associated fatality. Significant practice variation surrounds universal or contextual prescription of self-injectable Epinephrine (SIE) for patients receiving AIT. Objective To characterize the cost-effectiveness of a universal vs contextual SIE requirement for patients receiving AIT. Methods An economic evaluation using cohort and microsimulation was performed from both the societal and health care sector perspectives for patients undergoing AIT, assessing a universal requirement to fill SIE prescriptions at the outset of therapy compared with requiring this only after a systemic reaction to immunotherapy (SRIT). Results A universal SIE requirement for AIT is not cost-effective, with the incremental cost-effectiveness ratio for this strategy estimated at $669,327,730 per quality-adjusted life-year (QALY). In the microsimulation (n = 10,000), the mean (SD) costs of a universal approach exceeded that of a more context-specific strategy where SIE was only prescribed for patients after an initial SRIT ($19,653.36 [$4296.66] vs $16,232.14 [$5204.32]), and given the effects on rates of AIT discontinuation, the universal approach was less effective (mean [SD], 25.555 [2.285] QALYs) compared with a contextualized approach (mean [SD], 25.579 [2.345] QALYs). Universal SIE prescription could be cost-effective if it provided a 1000 times protection against AIT fatality at a value-based cost of $24, and the annual AIT fatality rates unrealistically exceed 2.6 per 10,000 patients. Conclusion In a simulation of potential SIE-prescribing strategies for patients receiving AIT, a universal approach to an Epinephrine Autoinjector requirement was not cost-effective when compared with an approach in which an SIE is prescribed only to patients with prior SRIT.
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guiding principles for the recognition diagnosis and management of infants with anaphylaxis an expert panel consensus
The Journal of Allergy and Clinical Immunology: In Practice, 2019Co-Authors: Matthew Greenhawt, Estelle F R Simons, Carlos A Camargo, Michael Pistiner, R Gupta, Allen J Meadows, Jonathan M Spergel, Philip LiebermanAbstract:Infant anaphylaxis is an emerging risk, with food allergy the most common cause. Although the presentation of anaphylaxis involves the same systems as in older children and adults, there are real-world challenges to identifying symptoms of an allergic emergency in nonverbal children, as well as implementing optimal treatment. Recognition of anaphylaxis in infants can be challenging because allergic symptoms and certain normal infant behaviors may overlap. Intramuscular Epinephrine is the treatment of choice for infants, as it is for older children and adults, and an Epinephrine Autoinjector approved by the Food and Drug Administration is now available for infants weighing between 7.5 and 15 kg. A panel of experts sought to develop guiding principles for the recognition, diagnosis, and management of anaphylaxis in infants, and provide a framework for the development of new guidelines and future research. Accordingly, anaphylaxis emergency action planning for infants was addressed by the panel. In considering formation of future infant anaphylaxis guidelines, health care providers should be aware of the needs to improve the recognition, diagnosis, and management of infants with anaphylaxis. Future research should identify and validate clinical criteria for the diagnosis of anaphylaxis in infants, as well as risk factors for the most severe reactions.
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association of fatality risk with value based drug pricing of Epinephrine Autoinjectors for children with peanut allergy a cost effectiveness analysis
JAMA network open, 2018Co-Authors: Marcus Shaker, Matthew GreenhawtAbstract:Importance The high cost of self-injectable Epinephrine Autoinjectors may represent a barrier to community anaphylaxis management. Value-based pricing can provide a benchmark for rational Epinephrine Autoinjector costs. Objective To define value-based pricing of community Epinephrine Autoinjectors. Design, Setting, and Participants In an economic evaluation study using a cost-effectiveness birth cohort model over an extended 80-year time horizon, Markov simulations of children with peanut allergy evaluated cost ceilings for value-based Epinephrine prices in peanut allergy. Simulation inputs included all-cause age-adjusted mortality (2013 US life tables), 2013 published food allergy fatality rates, 2017 rates of Autoinjector device carriage, and 2016 published market costs of self-injectable Epinephrine. All costs were expressed in 2018 US dollars and discounted at 3% per annum. Exposures Cohorts of children with peanut allergy prescribed Epinephrine Autoinjectors were compared with those not receiving personal Epinephrine prescriptions. Children without Epinephrine Autoinjectors assumed 10-fold to 100-fold fatality risk increases. Costs were evaluated from a societal perspective. Main Outcomes and Measures Fatality risk, quality-adjusted life-years, and incremental cost-effectiveness ratio. Results A total of 100 000 simulated infants with peanut allergy entered each strategy, with two-thirds of the group receiving annual personal Epinephrine prescriptions and using those devices appropriately when indicated. Over the time horizon, the cost of anaphylaxis preparedness and treatment in those with personal Epinephrine devices was $25 478 (95% CI, $25 399-$25 557) compared with $654 (95% CI, $645-$663) for those without personal Epinephrine, resulting in an average food allergy fatality of 0.00056 (95% CI, 0.000414-0.000706) per patient prescribed self-injectable Epinephrine and 0.00148 (95% CI, 0.001242-0.001718) in those not prescribed self-injectable Epinephrine. The value-based price (incremental cost-effectiveness ratio, $100 000 per quality-adjusted life-year) for personal Epinephrine based on 10-fold fatality risk difference was $24. At a market cost of $715 per twin pack, the Autoinjector incremental cost-effectiveness ratio was $2 742 697 per quality-adjusted life-year. If a hypothetical fatality risk protection from personal Epinephrine was modeled at 100-fold, the value-based price ceiling for a personal Autoinjector was $264. Conclusions and Relevance In a simulation of children with peanut allergy, a value-based Epinephrine cost has a ceiling of $24 for a personal Autoinjector, even at an exaggerated fatality risk.
Sunday Clark - One of the best experts on this subject based on the ideXlab platform.
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risk factors for severe anaphylaxis in patients receiving anaphylaxis treatment in us emergency departments and hospitals
The Journal of Allergy and Clinical Immunology, 2014Co-Authors: Sunday Clark, Wenhui Wei, Susan A Rudders, Carlos A CamargoAbstract:Background Although reported risk factors for severe anaphylaxis include older age, presence of comorbid medical conditions, and concomitant medications, previous studies have used varying definitions for anaphylaxis and heterogeneous methodology. Objective To describe risk factors for severe anaphylaxis among US patients treated in emergency departments (EDs) or hospitals for anaphylaxis. Methods Individuals with an ED visit/hospitalization for anaphylaxis were identified from 2 MarketScan Research Databases using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. Eligibility for the current study required continuous medical and prescription coverage for at least 1 year before and after the index date. Severe anaphylaxis was defined as a reaction requiring hospital admission. Results Among 11,972 individuals, 2,622 (22%) had severe anaphylaxis. Unadjusted analysis showed that severe anaphylaxis was associated with older age and higher comorbidity burden. These patients were also less likely to have filled an Epinephrine Autoinjector (EAI) prescription or visited an allergist/immunologist, but more likely to have had an ED visit/hospitalization (any cause). On multivariable analysis, filling an EAI prescription (odds ratio [OR], 0.64; 95% CI, 0.53-0.78) or visiting an allergist/immunologist (OR, 0.78; 95% CI, 0.63-0.95) before the index event was associated with a lower risk of severe anaphylaxis, while any previous ED visit (OR, 1.18; 95% CI, 1.07-1.30) or hospitalization (OR, 1.55; 95% CI, 1.36-1.75) was associated with a higher risk of severe anaphylaxis. Conclusions In this large cohort with an ED visit or hospitalization for anaphylaxis, 22% had severe anaphylaxis. Pre-index preventive anaphylaxis care (ie, EAI prescription fill and allergist/immunologist visit) was associated with a significantly lower risk, supporting the benefits of preventive anaphylaxis care in real-world practice.
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regional variation in Epinephrine Autoinjector prescriptions in australia more evidence for the vitamin d anaphylaxis hypothesis
Annals of Allergy Asthma & Immunology, 2009Co-Authors: Sunday Clark, Raymond J Mullins, Carlos A CamargoAbstract:Background There is little information on the regional distribution of anaphylaxis in Australia. Objective To examine the influence of latitude (a marker of sunlight/vitamin D status) as a contributor to anaphylaxis in Australia, with a focus on children from birth to the age of 4 years. Methods Epinephrine Autoinjector (EpiPen) prescriptions (2006-2007) in 59 statistical divisions and anaphylaxis hospital admission rates (2002-2007) in 10 regions were used as surrogate markers of anaphylaxis. Results EpiPen prescription rates (per 100,000 population per year) were higher in children from birth to the age of 4 years (mean, 951) than in the overall population (mean, 324). In an unadjusted model of children from birth to the age of 4 years, decreasing absolute latitude was associated with a decrease in EpiPen prescription rates, such that rates were higher in southern compared with northern regions of Australia (β, −44.4; 95% confidence interval, −57.0 to −31.8; P P Conclusions EpiPen prescription rates and anaphylaxis admissions are more common in southern regions of Australia. These data provide additional support for a possible role of vitamin D in the pathogenesis of anaphylaxis.
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anaphylaxis in the community learning from the survivors
The Journal of Allergy and Clinical Immunology, 2009Co-Authors: Estelle F R Simons, Sunday Clark, Carlos A CamargoAbstract:Background Most studies of anaphylaxis in the community focus on persons at risk who might, or might not, have experienced anaphylaxis. Objective We sought to focus on survivors of anaphylaxis in the community and their experiences in using, or not using, an Epinephrine Autoinjector for first-aid treatment. Methods An e-mail survey was conducted. Responses were anonymous and could not be traced to any person or location. Anaphylaxis was defined as the most severe sudden-onset allergic reaction ever experienced by the participants or a person for whom they were responsible (eg, a child). There were 17 core multiple-choice questions for all participants, with 16 additional questions for users who injected Epinephrine either into themselves or someone else, and 1 additional question for nonusers. Results Of the 1885 participants, 500 (27%) were Epinephrine users, and 1385 (73%) were nonusers. The groups were similar with regard to multisystem organ involvement (82% vs 78%, P = .07) and many other aspects of anaphylaxis; however, Epinephrine users were more likely (all P 1 -antihistamine (38%), no prescription for Epinephrine (28%), and/or a mild anaphylaxis episode (13%). Conclusions In a unique population composed of 1885 survivors of anaphylaxis in the community, users of Epinephrine Autoinjectors for first-aid treatment were outnumbered by nonusers. The insights reported by Epinephrine users and the reasons why nonusers did not inject Epinephrine are documented.
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anaphylaxis in the community learning from the survivors
The Journal of Allergy and Clinical Immunology, 2009Co-Authors: Estelle F R Simons, Sunday Clark, Carlos A CamargoAbstract:Background Most studies of anaphylaxis in the community focus on persons at risk who might, or might not, have experienced anaphylaxis. Objective We sought to focus on survivors of anaphylaxis in the community and their experiences in using, or not using, an Epinephrine Autoinjector for first-aid treatment. Methods An e-mail survey was conducted. Responses were anonymous and could not be traced to any person or location. Anaphylaxis was defined as the most severe sudden-onset allergic reaction ever experienced by the participants or a person for whom they were responsible (eg, a child). There were 17 core multiple-choice questions for all participants, with 16 additional questions for users who injected Epinephrine either into themselves or someone else, and 1 additional question for nonusers. Results Of the 1885 participants, 500 (27%) were Epinephrine users, and 1385 (73%) were nonusers. The groups were similar with regard to multisystem organ involvement (82% vs 78%, P = .07) and many other aspects of anaphylaxis; however, Epinephrine users were more likely (all P Conclusions In a unique population composed of 1885 survivors of anaphylaxis in the community, users of Epinephrine Autoinjectors for first-aid treatment were outnumbered by nonusers. The insights reported by Epinephrine users and the reasons why nonusers did not inject Epinephrine are documented.
Akilah Hugine - One of the best experts on this subject based on the ideXlab platform.
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Intelliject’s novel Epinephrine Autoinjector: sharps injury prevention validation and comparable analysis with EpiPen and
2015Co-Authors: Stephanie Guerlain, Lu Wang, Akilah HugineAbstract:Background—Currently marketed Epinephrine Autoinjectors (EAs) are prone to misuse that may lead to injury or a missed dose. A novel EA (NEA) (Intelliject Inc) was created to reduce such injuries by including features such as a unidirectional perceived injection end and a retractable needle. Objectives—To validate the sharps injury prevention features of the NEA and to obtain feedback on, and preference for, features of the NEA compared with Twinject and EpiPen. Methods—Twenty-eight health care professionals experienced with using the EpiPen or Twinject each injected 18 NEAs into an orange and provided confirmation of needle injection and retraction. Half of the injections were conducted using wet hands to replicate diaphoretic hands or wet environmental conditions. Participants provided feedback via a post-test questionnaire and gave ordinal preference rankings for the NEA, EpiPen, and Twinject based on shape, size, ease of use, ease of training, and overall preference. Participants also described known cases in which the Twinject or EpiPen was not correctly administered. Results—For all 505 tested NEAs, the needle injected and retracted as intended. For overall preference, 100 % of the experienced health care practitioners ranked the NEA first. Half of the participants recalled incidents in which the EpiPen or Twinject did not work as intended or caused an injury. Conclusions—The sharps injury prevention feature was verified for the NEA, and health care professionals experienced in the use of EpiPen and Twinject for allergic emergencies perceived the NEA to be a safer and preferred alternative
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intelliject s novel Epinephrine Autoinjector sharps injury prevention validation and comparable analysis with epipen and twinject
Annals of Allergy Asthma & Immunology, 2010Co-Authors: Stephanie Guerlain, Lu Wang, Akilah HugineAbstract:Background Currently marketed Epinephrine Autoinjectors (EAs) are prone to misuse that may lead to injury or a missed dose. A novel EA (NEA) (Intelliject Inc) was created to reduce such injuries by including features such as a unidirectional perceived injection end and a retractable needle. Objectives To validate the sharps injury prevention features of the NEA and to obtain feedback on, and preference for, features of the NEA compared with Twinject and EpiPen. Methods Twenty-eight health care professionals experienced with using the EpiPen or Twinject each injected 18 NEAs into an orange and provided confirmation of needle injection and retraction. Half of the injections were conducted using wet hands to replicate diaphoretic hands or wet environmental conditions. Participants provided feedback via a post-test questionnaire and gave ordinal preference rankings for the NEA, EpiPen, and Twinject based on shape, size, ease of use, ease of training, and overall preference. Participants also described known cases in which the Twinject or EpiPen was not correctly administered. Results For all 505 tested NEAs, the needle injected and retracted as intended. For overall preference, 100% of the experienced health care practitioners ranked the NEA first. Half of the participants recalled incidents in which the EpiPen or Twinject did not work as intended or caused an injury. Conclusions The sharps injury prevention feature was verified for the NEA, and health care professionals experienced in the use of EpiPen and Twinject for allergic emergencies perceived the NEA to be a safer and preferred alternative.
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a comparison of 4 Epinephrine Autoinjector delivery systems usability and patient preference
Annals of Allergy Asthma & Immunology, 2010Co-Authors: Stephanie Guerlai, Akilah Hugine, Lu WangAbstract:Background Prefilled Epinephrine Autoinjectors are sometimes improperly used by patients, caregivers, and physicians. A user-centered design process led to the development of 2 prototype Epinephrine Autoinjectors (INT01 and INT02) that have a unidirectional perceived injection end, a self-retracting needle, and, with INT02, voice instructions to assist in guiding users through administration. Objective To compare the usability and patient preference among 4 Epinephrine Autoinjectors: EpiPen, TwinJect, INT01, and INT02. Methods A total of 48 participants were divided equally among 3 age groups: 7 to 10, 11 to 15, and 16 to 55 years. In each group, half had prior TwinJect or EpiPen training. In 1-hour sessions, without training, participants performed simulated-use testing under observation for all 4 Epinephrine delivery systems. Usability (ie, the ability to perform the manufacturer's labeled instructions), task completion time, and preferences were assessed and analyzed based on device, age, previous experience, sex, device malfunction, and testing order. Results More participants correctly followed all device instructions with INT02 (22 [46%]) than with INT01 (13 [27%]), EpiPen (6 [12%]), or TwinJect (0 [0%]). The difference among devices was significant ( P P Conclusion The user-centered device design may have a significant impact on correct Epinephrine Autoinjector use and patient preference.