The adherence of parents regarding epinephrine auto-injector use in anaphylaxis management: a real-life study

Mahir Serbes; Ayşe Şenay Şaşihüseyinoğlu; Dilek Özcan; Rabia Miray Kisla Ekinci; Sibel Balcı; Derya Altintas

doi:10.17826/cumj.1246648

TR EN

Anafilaksi tedavisinde epinefrin oto-enjektör kullanımı konusunda ebeveynlerin uyumu: gerçek yaşamdan bir çalışma

Öz

Amaç: Bu çalışmanın amacı, ebeveyn(ler)in epinefrin oto-enjektörlerinin (EAI) kullanımına ilişkin pratik becerilerini değerlendirerek ve bunları etkileyen faktörleri belirleyerek anafilaksi yönetimindeki eksikleri belirlemektir. Gereç ve Yöntem: Çalışma, anafilaktik riski olan ve EAI reçete edilen 114 çocuk hastanın birincil bakıcısını yani ebeveynleri içeriyordu. Ebeveynlerle hem yüz yüze görüşme hem de bir EAI demo cihazı kullanılarak pratik beceri testi uygulanmıştır. Bulgular: Epinefrin, 93 ebeveyn (%81.6) tarafından anafilaksi için hayat kurtarıcı ve birinci basamak tedavi olarak tanımlandı. Ancak sadece 53 ebeveyn (%46.5) günlük yaşamlarında EAI cihazını düzenli olarak taşıdıklarını belirtti. 38 çocukta (%33.3) tekrarlayan ataklar olduğu saptandı. Bu hastalarda EAI cihazını taşımasına rağmen sadece 6 ebeveynin (%20) EAI cihazını uyguladığı saptandı. Katılımcılara göre AEI'nin düzenli taşınmasını engelleyen ana faktör, gerekliliğe olan inanç eksikliğiydi (18, %29.5). Katılımcılar arasında, ebeveynlerin sadece 13'ü (%11.4) EAI'yi tüm basamaklarda doğru şekilde uygulayabildi. Cihazı kullanma becerisi ile son ziyaretten bu yana geçen süre arasında ters bir ilişki bulundu. Sonuç: Ebeveynler arasındaki EAI kullanımı konusunda bulunan düşük uyum seviyeleri, bu durumu iyileştirmeye yönelik acil ihtiyacın altını çizmiştir. Ebeveynlere yönelik düzenli EAI doğru kullanım eğitimlerinin yanı sıra psikolojik destek de dahil olmak üzere daha kapsamlı müdahaleler sağlanmalıdır, ancak bu müdahaleler bile gerçek hayatta EAI'lere kazanılmış uyumu sürdürmeyi garanti etmeyebilir.

Anahtar Kelimeler

anafilaksi , çocuklar , ebeveynler , epinefrin otoenjektör , uyum

The adherence of parents regarding epinephrine auto-injector use in anaphylaxis management: a real-life study

Abstract

Purpose: The purpose of this study was to identify unmet needs in the management of anaphylaxis by assessing the practical skills of the parent(s) regarding the use of epinephrine auto-injectors (EAIs) and determining the factors influencing them. Materials and Methods: The study included 114 primary caregivers of children prescribed an EAI with an anaphylaxis risk. A structured mini-interview with a practice test using a trainer device was performed. Results: Epinephrine was described as a life-saving and first-line treatment for anaphylaxis by 93 parents (81.6%). However, only 53 parents (46.5%) stated that they carry an EIA device with them regularly in their daily lives. 38 children (33.3%) had relapsing episodes, but among those experiencing anaphylaxis, only 6 parents (20%) used EAI despite carrying. According to respondents, the main factor avoiding AEI's regular carriage was a lack of belief in necessity (18, 29.5%). Among participants, only 13 (11.4%) of the parents were able to administer EAI correctly in all 5 steps. An inverse relationship between the ability to use the device and the time elapsed since the last visit s was found. Conclusion: Low adherence levels among parents highlighted the urgent need to improve this situation. Interventions including regular EAI training and psychological support should be provided among parents, but may not guarantee to maintain acquired adherence to EAIs in real life.

Keywords

anaphylaxis , children , parents , epinephrine auto-injector , adherence

Kaynakça

Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13:100472.
Prince BT, Mikhail I, Stukus DR. Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities. J Asthma Allergy. 2018;11:143-151.
Grabenhenrich LB, Dölle S, Moneret-Vautrin A, Kayli A, Lange L, Spindler T et al. Anaphylaxis in children and adolescents: The European Anaphylaxis Registry. J Allergy Clin Immunol. 2016;137:1128-1137.
Serbes M, Sasihuseyinoglu AS, Ozcan D, Ufuk Altıntas D. Clinical features of anaphylaxis in children. Allergy Asthma Proc. 2022;43(1):50-56.
Esenboga S, Ocak M, Cetinkaya PG, Sahiner UM, Soyer O, Buyuktiryaki B et al. Physicians prescribe adrenaline autoinjectors, do parents use them when needed? Allergol Immunopathol (Madr). 2020;48:3-7.
Topal E, Bakirtas A, Yilmaz O, Ertoy IH, Arga M, Demirsoy MS et al. A real-life study on acquired skills from using an adrenaline autoinjector. Int Arch Allergy Immunol. 2013;160:301-6.
Ito K, Ono M, Kando N, Matsui T, Nakagawa T, Sugiura S et al. Surveillance of the use of adrenaline auto-injectors in Japanese children. Allergol Int. 2018;67:195-200.
Feuille E, Lawrence C, Volel C, Sicherer SH, Wang J. Time trends in food allergy diagnoses, epinephrine orders, and epinephrine administrations in New York City Schools. J Pediatr. 2017;190:93-99.
Kahveci M, Akarsu A, Koken G, Sahiner UM, Soyer O, Sekerel BE. Food-induced anaphylaxis in infants, as compared to toddlers and preschool children in Turkey. Pediatr Allergy Immunol. 2020;31:954-961.
Ratanaprug C, Srisuwatchari W, Jirapongsananuruk O, Visitsunthorn N, Pacharn P. Carrying rates of epinephrine devices in children with food-induced anaphylaxis. Asia Pac Allergy. 2019;9:e12.

Saleh-Langenberg J, Flokstra-de Blok BM, Goossens NJ, Kemna JC, van der Velde JL, Dubois AE. The compliance and burden of treatment with the epinephrine auto-injector in food-allergic adolescents. Pediatr Allergy Immunol. 2016;27:28-34.
Carrillo E, Hern HG, Barger J. Prehospital administration of epinephrine in pediatric anaphylaxis. Prehosp Emerg Care. 2016;20:239-44.
Marrs T, Lack G. Why do few food-allergic adolescents treat anaphylaxis with adrenaline?--Reviewing a pressing issue. Pediatr Allergy Immunol. 2013;24:222-9.
Wijekoon CN, Wettasinghe I, Fernando D, Dissanayake AS, Gunawardana M, Minuwanpitiya G et al. Preparedness of pre-intern medical graduates of three universities in Sri Lanka to diagnose and manage anaphylaxis. BMC Med Educ. 2021;21:152.
Topal E, Çatal F, Özdemir R, Karadağ A, Yildirim N, Ermiş Tekin H et al. Measuring the primary care physician's knowledge about diagnosis and treatment of cow's milk allergy and adrenaline auto injector usage. Asthma Allergy Immunology. 2014;12:9-14.
Gallagher M, Worth A, Cunningham-Burley S, Sheikh A. Epinephrine auto-injector use in adolescents at risk of anaphylaxis: a qualitative study in Scotland, UK. Clin Exp Allergy. 2011;41:869–77.
Chooniedass R, Temple B, Martin D, Becker A. A qualitative study exploring parents' experiences with epinephrine use for their child's anaphylactic reaction. Clin Transl Allergy. 2018;8:43.
Pouessel G, Deschildre A, Castelain C, Sardet A, Sagot-Bevenot S, de Sauve-Boeuf A et al. Parental knowledge and use of epinephrine auto-injector for children with food allergy. Pediatr Allergy Immunol. 2006;17:221-6.
Dobbin-Williams KA. Understanding the experiences of mothers of teenaged children with life-threatening food allergies: A philosophical hermeneutic inquiry, nursing. Ann Arbor: University of Calgary (Canada). 2019;164.
Parke L, Senders AS, Bindslev-Jensen C, Lassen AT, Oropeza AR, Halken S et al. Adherence to adrenaline autoinjector prescriptions in patients with anaphylaxis. Clin Transl Allergy. 2019;9:59.
Sirin Kose S, Asilsoy S, Tezcan D, Al S, Atay O, Kangalli O, Uzuner N et al. Is there an optimal training interval to improve the correct use of adrenaline auto-injectors? Int Arch Allergy Immunol. 2020;181:136-140.
Topal E, Karagöl HİE, Yılmaz Ö, Arga M, Köksal B, Yılmaz ÖÖ et al. Comparison of practical application steps of the previously used adrenaline auto injector in Turkey (EpiPen) and the currently available adrenaline auto injector (Penepin): a multi-center study. Turk Pediatri Ars. 2018;53:149-154.
Salter SM, Loh R, Sanfilippo FM, Clifford RM. Demonstration of epinephrine autoinjectors (EpiPen and Anapen) by pharmacists in a randomised, simulated patient assessment: acceptable, but room for improvement. Allergy Asthma Clin Immunol. 2014;10:49.
Ridolo E, Montagni M, Bonzano L, Savi E, Peveri S, Costantino MT et al. How far from correct is the use of adrenaline auto-injectors? A survey in Italian patients. Intern Emerg Med. 2015;10:937–41.
Bakirtas A, Arga M, Catal F, Derinoz O, Demirsoy MS, Turktas I. Make-up of the epinephrine autoinjector: the effect on its use by untrained users. Pediatr Allergy Immunol. 2011;22:729-33.
Waserman S, Avilla E, Ben-Shoshan M, Rosenfield L, Adcock AB, Greenhawt M. Epinephrine autoinjectors: new data, new problems. J Allergy Clin Immunol Pract. 2017;5:1180-91.
Gates M, Shulhan-Kilroy J, Featherstone R, MacGregor T, Scott SD, Hartling L. Parent experiences and information needs related to bronchiolitis: A mixed studies systematic review. Patient Educ Couns. 2019;102:864-78.

Ayrıntılar

Birincil Dil

İngilizce

Konular

Klinik Tıp Bilimleri

Bölüm

Araştırma Makalesi

Yazarlar

Mahir Serbes ^*
0000-0001-6422-2639
Türkiye

Ayşe Şenay Şaşihüseyinoğlu
0000-0003-4085-0256
Türkiye

Dilek Özcan
0000-0003-3972-7277
Türkiye

Rabia Miray Kisla Ekinci
0000-0001-6234-822X
Türkiye

Sibel Balcı
0000-0003-4558-361X
Türkiye

Derya Altintas
0000-0003-2090-5248
Türkiye

Yayımlanma Tarihi

31 Mart 2023

Gönderilme Tarihi

2 Şubat 2023

Kabul Tarihi

27 Şubat 2023

Yayımlandığı Sayı

Yıl 2023 Cilt: 48 Sayı: 1

DOI

https://doi.org/10.17826/cumj.1246648

IZ

https://izlik.org/JA93FE39BM

MLA

Serbes, Mahir, vd. “The adherence of parents regarding epinephrine auto-injector use in anaphylaxis management: a real-life study”. Cukurova Medical Journal, c. 48, sy 1, Mart 2023, ss. 234-42, doi:10.17826/cumj.1246648.

Cited By

Proper use of epinephrine autoinjectors is related to device type, prior physical demonstration, and sociodemographic factors

The Journal of Allergy and Clinical Immunology: In Practice

https://doi.org/10.1016/j.jaip.2024.11.006

Bu eser Creative Commons Atıf-Gayriticari-Türetilemez 4.0 Uluslararası Lisansı ile lisanslanmıştır.

Anafilaksi tedavisinde epinefrin oto-enjektör kullanımı konusunda ebeveynlerin uyumu: gerçek yaşamdan bir çalışma

Öz

Anahtar Kelimeler

The adherence of parents regarding epinephrine auto-injector use in anaphylaxis management: a real-life study

Abstract

Keywords

Kaynakça

Ayrıntılar

Birincil Dil

Konular

Bölüm

Yazarlar

Yayımlanma Tarihi

Gönderilme Tarihi

Kabul Tarihi

Yayımlandığı Sayı

DOI

IZ

Kaynak Göster

Cited By

Proper use of epinephrine autoinjectors is related to device type, prior physical demonstration, and sociodemographic factors