Management of Children With Food-Induced Anaphylaxis: A Cross-Sectional Survey of Parental Knowledge, Attitude, and Practices

Background Anaphylaxis is a life-threatening event, but it is frequently undertreated in pediatric patients with food allergies. Previous studies showed that auto-injectable adrenaline (AAI) is underused by patients and parents. This is especially troubling since fatal anaphylaxis has been associated with delayed adrenaline administration. Objectives This study aimed to investigate parental practice and knowledge in anaphylaxis management, and perceived barriers and facilitators in using AAI. Results A retrospective survey was completed by 75 parents (41 mothers, 34 fathers) of children with food allergy and AAI prescription attending the Food Allergy Referral Center of Veneto, Italy. Results showed poor parental preparedness and reluctance to use AAI despite a high/moderate self-rated knowledge (median total score of 23–min. 3, max. 30). Most parents (77%) declared they were carrying AAI but only 20% used it in case of a severe reaction. Most reported Fear/Fear of making mistakes (46 parents) and Concern about possible side effects as barriers (35), while Poor knowledge of the correct AAI use (1) and Lack of knowledge/ incorrect assessment of symptoms (2) were reported less frequently. Theoretical-practical courses for parents on AAI use (65), Psycho-education/Psychological support (3) for better dealing with the emotional aspects of anaphylaxis and Written instructions (1) have been suggested as main facilitators. Conclusion Understanding parents' experience and perspective on managing anaphylaxis is crucial to implement effective educational programs. A multidisciplinary approach should be considered.

[1]  E. Baraldi,et al.  Psychological Wellbeing of Parents with Infants Admitted to the Neonatal Intensive Care Unit during SARS-CoV-2 Pandemic , 2021, Children.

[2]  A. Muraro,et al.  EAACI guidelines: Anaphylaxis (2021 update) , 2021, Allergy.

[3]  F. Lazzarotto,et al.  Maternal anxiety and previous anaphylaxis are associated with alexithymia in young patients with food allergy , 2021, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[4]  J. Soar,et al.  Evidence update for the treatment of anaphylaxis , 2021, Resuscitation.

[5]  L. Yamamoto,et al.  Patient/parent administered epinephrine in acute anaphylaxis. , 2020, The American journal of emergency medicine.

[6]  T. Vanniasinkam,et al.  Parent perceptions in managing children with food allergy: An Australian perspective , 2020, The World Allergy Organization journal.

[7]  Julie Wang,et al.  Factors contributing to underuse of epinephrine autoinjectors in pediatric patients with food allergy , 2020, Annals of Allergy, Asthma & Immunology.

[8]  Post-anaphylaxis acute stress symptoms: a preliminary study on children with food-induced anaphylaxis and their parents. , 2020, The journal of allergy and clinical immunology. In practice.

[9]  F. Lazzarotto,et al.  Multidisciplinary education improves school personnel’s self‐efficacy in managing food allergy and anaphylaxis , 2020, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[10]  S. Halken,et al.  Adherence to adrenaline autoinjector prescriptions in patients with anaphylaxis , 2019, Clinical and Translational Allergy.

[11]  P. Pacharn,et al.  Carrying rates of epinephrine devices in children with food-induced anaphylaxis , 2019, Asia Pacific allergy.

[12]  F. Simons,et al.  Guiding Principles for the Recognition, Diagnosis, and Management of Infants with Anaphylaxis: An Expert Panel Consensus. , 2019, The journal of allergy and clinical immunology. In practice.

[13]  Charles Feng,et al.  Beyond Avoidance: the Psychosocial Impact of Food Allergies , 2018, Clinical Reviews in Allergy & Immunology.

[14]  D. Stukus,et al.  Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities , 2018, Journal of asthma and allergy.

[15]  A. Muraro,et al.  Food allergy and attitudes to close interpersonal relationships: An exploratory study on attachment , 2017, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[16]  M. Kowalski,et al.  Anaphylaxis in children and adolescents: The European Anaphylaxis Registry. , 2016, The Journal of allergy and clinical immunology.

[17]  Paul J. Turner,et al.  Increase in anaphylaxis-related hospitalizations but no increase in fatalities: An analysis of United Kingdom national anaphylaxis data, 1992-2012 , 2015, The Journal of allergy and clinical immunology.

[18]  Julie Wang,et al.  International survey of knowledge of food‐induced anaphylaxis , 2014, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[19]  A. Muraro,et al.  EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy , 2014, Allergy.

[20]  A. Sheikh,et al.  Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology , 2014, Allergy.

[21]  A. Sheikh,et al.  International consensus on (ICON) anaphylaxis , 2014, The World Allergy Organization journal.

[22]  M. Ben-Shoshan,et al.  A majority of parents of children with peanut allergy fear using the epinephrine auto‐injector , 2013, Allergy.

[23]  EAACI Food Allergy and Anaphylaxis Guidelines , 2013 .

[24]  G. Toit,et al.  The use of adrenaline autoinjectors by children and teenagers , 2012, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[25]  A. Cummings,et al.  The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review , 2010, Allergy.

[26]  L. Senelick It (review) , 2008 .

[27]  P. Arkwright,et al.  Factors determining the ability of parents to effectively administer intramuscular adrenaline to food allergic children , 2006, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[28]  A. Deschildre,et al.  Parental knowledge and use of epinephrine auto‐injector for children with food allergy , 2006, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[29]  J. Gordon Australian perspective. , 2006, BMJ.

[30]  J. Sinacore,et al.  Parental use of EpiPen for children with food allergies. , 2005, The Journal of allergy and clinical immunology.

[31]  F. Muñoz-López . . . and clinical immunology? , 2000, Allergologia et immunopathologia.

[32]  Pumphrey Lessons for management of anaphylaxis from a study of fatal reactions , 2000, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[33]  R. Sainsbury,et al.  First aid anaphylaxis management in children who were prescribed an epinephrine autoinjector device (EpiPen). , 2000, The Journal of allergy and clinical immunology.

[34]  P. McGinn Missed opportunities. , 2000, Hospitals & health networks.