Adrenalin Otoenjektör Reçete Edilen Çocukların Klinik Özelliklerinin Değerlendirilmesi

Abstract

Amaç: Adrenalin, anafilaksinin tedavisinde bilinen tek hayat kurtarıcı birinci basamak tedavidir. Adrenalin otoenjektörleri (AOE), anafilaksi geçirmiş hastalara ve gelecekte anafilaksi riski artmış seçilmiş bireylere reçete edilmektedir. Bu çalışmanın amacı, AOE reçete edilen çocukların klinik özelliklerini, reçete endikasyonlarını ve anafilaksi tetikleyicilerini değerlendirmektir.

Gereç ve Yöntemler: Bu retrospektif çalışmaya, 1 Temmuz 2024 ile 1 Temmuz 2025 tarihleri arasında bir çocuk alerji ve immünoloji kliniğinde AOE reçete edilen 0–18 yaş arası çocuklar dahil edildi. Demografik ve klinik özellikler, reçete endikasyonları, anafilaksi öyküsü ve tetikleyicileri ile daha önceki AOE reçetesi ve kullanımına ilişkin veriler tıbbi kayıtlardan retrospektif olarak elde edildi.

Bulgular: Çalışmaya toplam 98 çocuk dahil edildi; 64’ü (%65,3) erkekti ve ortanca yaş 96,5 ay (ÇAA, 56,5–177,0) [aralık, 6–211] idi. AOE, 80 hastaya (%81,6) anafilaksi nedeniyle, 18 hastaya (%18,4) ise anafilaksi olmamasına rağmen gelecekte anafilaksi riskinin yüksek olduğu düşünülmesi nedeniyle reçete edilmişti. Bu yüksek riskli grupta endikasyonlar besin alerjisi (n=8), mastositoz (n=6), venom alerjisi (n=3) ve soğuk ürtikeri (n=1) idi. Anafilaksisi olan hastaların 66’sında (%82,5) akut anafilaksi, 14’ünde (%17,5) geçirilmiş anafilaksi öyküsü vardı. En sık tetikleyiciler besinler (n=35, %43,8), ilaçlar (n=31, %38,7), venom (n=8, %10,0), kedi maruziyeti (n=2, %2,5) ve diğer veya idiyopatik nedenlerdi (n=4, %5,0). Akut anafilaksi ile başvuran ve daha önce AOE reçetesi bulunan 7 hastadan yalnızca 1’inin atak sırasında AOE kullandığı belirlendi.

Sonuç: AOE’lerin çoğu anafilaksi nedeniyle, bir kısmı ise bilinen risk faktörlerine dayanarak reçete edilmiştir. AOE reçeteleme kararları, güncel kılavuz önerileri doğrultusunda bireyselleştirilmelidir.

Keywords

• Adrenalin otoenjektör
• anafilaksi
• besin alerjisi
• mastositoz
• venom alerjisi

Ethical Statement

Bu çalışma, Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüş ve 10 Eylül 2025 tarihinde Ankara Atatürk Sanatoryumu Eğitim ve Araştırma Hastanesi Bilimsel Araştırma Etik Kurulu tarafından onaylanmıştır (Onay No: 2024-BÇEK/353).

Evaluation of Clinical Characteristics of Children Prescribed Adrenaline Autoinjector

Abstract

Aim: Adrenaline is the only life-saving first-line treatment for anaphylaxis. Adrenaline autoinjectors (AAIs) are prescribed for patients with anaphylaxis and selected individuals at increased future risk. This study aimed to evaluate the clinical characteristics, prescription indications, and anaphylaxis triggers of children prescribed AAI.

Material and Methods: This retrospective study included children aged 0–18 years who were prescribed an AAI at a pediatric allergy and immunology clinic between July 1, 2024 and July 1, 2025. Demographic and clinical characteristics, prescription indications, anaphylaxis history and triggers, and data on previous AAI prescription and use were retrospectively extracted from medical records.

Results: A total of 98 children were included; 64 (65.3%) were male, and the median age was 96.5 months (IQR, 56.5–177.0) [range, 6–211]. AAIs were prescribed for anaphylaxis in 80 patients (81.6%) and based on recognized risk factors in 18 patients (18.4%) without anaphylaxis. In this high-risk group, indications were food allergy (n=8), mastocytosis (n=6), venom allergy (n=3), and cold urticaria (n=1). Among patients with anaphylaxis, 66 (82.5%) had acute anaphylaxis and 14 (17.5%) had previous anaphylaxis. The most common triggers were foods (n=35, 43.8%), drugs (n=31, 38.7%), venom (n=8, 10.0%), cat exposure (n=2, 2.5%), and other or idiopathic causes (n=4, 5.0%). Of 7 patients with acute anaphylaxis and a previous AAI prescription, only 1 used it during the episode.

Conclusion: Most AAIs were prescribed for anaphylaxis, while some were prescribed based on recognized risk factors. AAI prescribing decisions should be individualized according to current guideline recommendations.

Keywords

• Adrenaline autoinjector
• anaphylaxis
• food allergy
• mastocytosis
• venom allergy

Ethical Statement

This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Scientific Research Ethics Committee of Ankara Atatürk Sanatorium Training and Research Hospital on September 10, 2025 (Approval No: 2024-BÇEK/353).

References

1. Cardona V. Overview of allergic disease: anaphylaxis - WAO White Book on Allergy 2026 - 2.11. World Allergy Organ J. 2026;19(3):101338. doi:10.1016/j.waojou.2026.101338.
2. Muraro A, Worm M, Alviani C, Cardona V, DunnGalvin A, Garvey LH, et al. EAACI guidelines: anaphylaxis (2021 update). Allergy. 2022;77(2):357-77. doi:10.1111/all.15032.
3. 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(10):100472. doi:10.1016/j.waojou.2020.100472.
4. Sim M, Sharma V, Li K, Gowland MH, Garcez T, Shilladay C, et al. Adrenaline auto-injectors for preventing fatal anaphylaxis. Clin Exp Allergy. 2025;55(1):19-35. doi:10.1111/cea.14565.
5. Regent L, Johnson D. Adrenaline autoinjectors. Clin Exp Allergy. 2020;50(6):652-3. doi:10.1111/cea.13615.
6. Arga M, Bakırtaş A. Adrenalin otoenjektörlerin dünü, bugünü ve yarını. Astım Allerji İmmünoloji. 2011;9(3):115-22.
7. 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(3):149-54. doi:10.5152/TurkPediatriArs.2018.6734.
8. Boyle RJ, Shamji MH. Adrenaline auto-injectors for people at risk of anaphylaxis. Clin Exp Allergy. 2023;53:896-8. doi:10.1111/cea.14380.

9. Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, et al. The management of anaphylaxis in childhood: position paper of the European Academy of Allergology and Clinical Immunology. Allergy. 2007;62(8):857-71. doi:10.1111/j.1398-9995.2007.01421.x.
10. Nemat K, Abraham S. Cutaneous mastocytosis in childhood. Allergol Sel. 2022;6:1-10. doi:10.5414/ALX02304E.
11. Ertugrul A, Baskaya N, Cetin S, Bostanci I. Anaphylaxis and epinephrine autoinjector use in pediatric patients with cutaneous mastocytosis. Pediatr Dermatol. 2021;38(5):1080-5. doi:10.1111/pde.14800.
12. Bizjak M, Košnik M, Dinevski D, Thomsen SF, Fomina D, Borzova E, et al. Risk factors for systemic reactions in typical cold urticaria: results from the COLD-CE study. Allergy. 2022;77(7):2185-99. doi:10.1111/all.15194.
13. Tomei L, Saretta F, Arasi S, Sarti L, Licari A, Giovannini M, et al. Cold anaphylaxis in children: Italian case series and review of the literature. Diseases. 2023;11(4):143. doi:10.3390/diseases11040143.
14. VEM İlaç. Penepin JR 0.15 mg/0.3 mL I.M. enjeksiyonluk çözelti içeren oto-enjektör: Kullanma talimatı. [Internet]. [cited 2026 Aug 13]. Available from: https://vemilac.com/download_kubkt_file/penepin-jr-0-15mg-0-3-ml-i-m-enjeksiyonluk-cozelti-iceren-oto-enjektor-kt.pdf
15. VEM İlaç. Penepin 0.3 mg/0.3 mL I.M. enjeksiyonluk çözelti içeren oto-enjektör: Kısa Ürün Bilgisi. [Internet]. [cited 2026 Aug 13]. Available from: https://vemilac.com/download_kubkt_file/penepin-0-3mg-0-3-ml-i-m-enjeksiyonluk-cozelti-iceren-oto-enjektor-kub.pdf
16. Aytekin Güvenir F, Yörüsün G, Dere R, Selmanoğlu A, Şengül Emeksiz Z, Dibek Mısırlıoğlu E. Retrospective evaluation of pediatric anaphylaxis cases according to WAO and NIAID/FAAN/EAACI criteria: a single center experience. World Allergy Organ J. 2024;17(11):100982. doi:10.1016/j.waojou.2024.100982.
17. Orhan F, Canitez Y, Bakirtas A, Yilmaz O, Boz AB, Can D, et al. Anaphylaxis in Turkish children: a multi-centre, retrospective, case study. Clin Exp Allergy. 2011;41(12):1767-76. doi:10.1111/j.1365-2222.2011.03859.x.
18. Grabenhenrich LB, Dölle S, Moneret-Vautrin A, Köhli A, Lange L, Spindler T, et al. Anaphylaxis in children and adolescents: the European Anaphylaxis Registry. J Allergy Clin Immunol. 2016;137(4):1128-37.e1. doi:10.1016/j.jaci.2015.11.015.
19. 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(8):954-61. doi:10.1111/pai.13320.
20. Tanno LK, Demoly P. Anaphylaxis in children. Pediatr Allergy Immunol. 2020;31(Suppl 26):8-10. doi:10.1111/pai.13336.
21. Vezir E, Erkoçoğlu M, Kaya A, Toyran M, Özcan C, Akan A, et al. Characteristics of anaphylaxis in children referred to a tertiary care center. Allergy Asthma Proc. 2013;34(3):239-46. doi:10.2500/aap.2013.34.3654.
22. Topal E, Bakirtas A, Yilmaz O, Ertoy Karagol IH, Arga M, Demirsoy MS, et al. Anaphylaxis in infancy compared with older children. Allergy Asthma Proc. 2013;34(3):233-8. doi:10.2500/aap.2013.34.3658.
23. Celiksoy MH, Ulas S, Turan I, Yıldırım I, Ucar OT, Al S. Characteristics of childhood anaphylaxis in different age groups. Allergol Immunopathol (Madr). 2024;52(5):1-5. doi:10.15586/aei.v52i5.1131.
24. Serbes M, Sasihuseyinoglu AS, Ozcan D, Ufuk Altıntas D. Clinical features of anaphylaxis in children. Allergy Asthma Proc. 2022;43(1):50-6. doi:10.2500/aap.2022.43.210089.
25. Başkaya N, Ertuğrul A, Esenboğa S, Özmen S. Different age groups present different clinics in anaphylaxis with children: one size does not fit all children. Turkish J Med Sci. 2023;53(2):495-503. doi:10.55730/1300-0144.5609.
26. Dribin TE, Waserman S, Turner PJ. Who needs epinephrine? Anaphylaxis, autoinjectors, and parachutes. J Allergy Clin Immunol Pract. 2023;11(4):1036-46. doi:10.1016/j.jaip.2023.02.002.
27. Vezir E, Kaya A, Toyran M, Azkur D, Dibek Mısırlıoğlu E, Kocabaş CN. Anaphylaxis/angioedema caused by honey ingestion. Allergy Asthma Proc. 2014;35(1):71-4. doi:10.2500/aap.2014.35.3718.
28. Shah S, Grohman R, Nowak-Wegrzyn A. Food protein-induced enterocolitis syndrome (FPIES): beyond the guidelines. J Food Allergy. 2023;5(2):55-64. doi:10.2500/jfa.2023.5.230014.
29. Klaiber N, Kumar S, Irani A-M. Mastocytosis in children. Curr Allergy Asthma Rep. 2017;17(11):80. doi:10.1007/s11882-017-0748-4.
30. Matito A, Carter M. Cutaneous and systemic mastocytosis in children: a risk factor for anaphylaxis? Curr Allergy Asthma Rep. 2015;15(5):22. doi:10.1007/s11882-015-0525-1.
31. Karakurt T. Risk and management of anaphylaxis in childhood mastocytosis. In: Özdemir Ö, editor. Childhood mastocytosis: new developments in diagnosis and treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p. 195-207.
32. Prosty C, Gabrielli S, Le M, Ensina LF, Zhang X, Netchiporouk E, et al. Prevalence, management, and anaphylaxis risk of cold urticaria: a systematic review and meta-analysis. J Allergy Clin Immunol Pract. 2022;10(2):586-96.e4. doi:10.1016/j.jaip.2021.10.012.
33. 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(1):3-7. doi:10.1016/j.aller.2019.07.009.
34. Turgay Yagmur I, Yilmaz Topal O, Kulhas Celik I, Toyran M, Civelek E, Dibek Misirlioglu E. Evaluation of anaphylaxis recurrence and adrenaline autoinjector use in childhood. Allergy Asthma Proc. 2021;42(3):e96-100. doi:10.2500/aap.2021.42.210007.