Use of Adrenaline Autoinjectors in Paediatric Immunology Clinic – A Single Centre Experience

Background: Anaphylaxis accounts for 1 in 1,000 admissions to paediatric units in the UK and this figure is increasing year on year. Immediate management of anaphylaxis includes antihistamines followed by intramuscular injection of adrenaline should symptoms continue. Adrenaline autoinjectors (AAIs) are prescribed to quicken treatment of anaphylaxis (0.15mg for a young child or 0.3mg for a child or teenager). Literature around the number of AAIs prescribed in a paediatric setting is limited.

Objective: We aimed to quantify provision of AAIs in a paediatric centre and define the diagnoses, indications of prescribing and associated atopic comorbidities.

Methods: Retrospective analysis of the notes of 106 consecutive patients attending paediatric allergy clinic at a single centre between December 2015 and May 2016.

Results: Patient age range was 0 – 17 years old; 72 patients were male and 34 female. 37 (35%) patients had a current AAI, the final diagnosis of which included: food allergy – 30 patients; idiopathic – 2 patients; atopic disease – 2 patients; venom allergy – 1 patient; other allergy – 2 patients. In the AAI group associated atopy included: 16 patients with eczema; 20 with asthma; and 1 with allergic rhinitis. 27 patients (73%) provided with an AAI had a confirmed nut allergy. 34 of the 37 AAI patients (92%) were also prescribed an antihistamine. Within the whole cohort, there were 5 Emergency Department attendances due to allergy in the last year.

Conclusion: 1 in 3 patients had a current AAI. The most common indication was food allergy, specifically nut allergy. This may be explained by the higher prevalence of asthma in this setting. Prevalence of asthma and allergic rhinitis was highest in patients with a current AAI. It is important to review the prescription of AAIs regularly, with parental education on method of use. Management plans are provided to parents, nursery and schools.