The use of adrenaline autoinjectors by children and teenagers
The use of adrenaline autoinjectors by children and teenagers
复制标题
DOI：
10.1111/j.1365-2222.2011.03912.x
复制
发表时间：
2012-02-01
影响因子：
6.1
通讯作者：
Roberts, G.
中科院分区：
文献类型：
--
作者：
Noimark, L.;Wales, J.;Roberts, G.
背景 尽管肾上腺素被推荐作为过敏反应的一线治疗方法，但通常不被使用。关于何时应使用肾上腺素自动注射器以及应分配多少量一直存在争议。 目的 了解在过敏反应期间使用了多少肾上腺素自动注射器，并确定为什么在有临床指征的情况下不使用它们。 方法 在英国 14 家儿科过敏诊所前瞻性招募患者。参与者完成了一份调查问卷，内容包括人口统计数据、特应性状态和前一年过敏反应的详细信息以及使用多个设备的原因。 结果 总共招募了 969 名患者，其中 466 名患者（48.1%，95% CI：37.9-58.2）在前一年至少有过一次反应；其中 245 例（25.3%，95% CI：16.2-34.4）为过敏反应。 41 名（16.7%，95% CI：11.7-21.3）经历过敏反应的参与者使用了肾上腺素自动注射器。 13 名参与者接受了不止一剂肾上腺素，其中 9 名参与者至少接受了一剂。使用超过一种药物的最常见原因是严重呼吸困难（40%）、首次剂量没有改善（20%）和误射（13.3%）。在过敏反应中不使用肾上腺素的最常见原因是“认为不需要肾上腺素”（54.4%）和“不确定是否需要肾上腺素”（19.1%）。许多喘息患者没有使用自动注射器。 结论和临床相关性 社区中只有少数经历过敏反应的患者使用肾上腺素。 41 名使用自动注射器的过敏反应患者中有 13 名需要另一剂肾上腺素。需要进一步的研究来考虑当临床表明过敏反应时如何最好地鼓励使用肾上腺素。
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.