Children at risk of anaphylaxis: A mixed-studies systematic review of parents' experiences and information needs

Prevalence and Characteristics of Accidental Ingestions Among Pediatric Food Allergy Patients

BACKGROUND

Despite a known diagnosis of food allergy, accidental ingestions continue to occur.

OBJECTIVE

To characterize accidental ingestions, including prevalence, risk factors, food allergen triggers, and severity of reactions.

METHODS

A prospective monthly survey developed by the Food Allergy Consortium at Northwestern University was administered to parents of food-allergic children between April 2015 and April 2017. The monthly survey included questions on any allergic reactions experienced in the previous month. In addition, chart reviews of 100 pediatric participants from Lurie Children's Hospital of Chicago allergy clinics (typical clinical encounters) were compared with the prospective survey results.

RESULTS

A total of 196 survey participants and 100 retrospective review subjects were analyzed-31.1% of participants from the surveyed cohort and 19.0% of participants from the retrospective review reported at least 1 accidental ingestion over 1 year. The rate of accidental ingestions reported in the prospective survey was high: 10% to 25% of participants each month reported an accidental ingestion, and multiple ingestions were common. Common triggers were milk, wheat, and tree nuts. In the retrospective cohort, the highest rate of accidental ingestion (25.0%) occurred for milk, followed by sesame (20.0%) and egg (18.8%). Rates of anaphylaxis after exposure were high in both the prospective and retrospective cohorts (33.1% and 16.7%, respectively).

CONCLUSIONS

Accidental ingestion rates were high among food-allergic patients. Multiple exposures, especially to milk, were common. Incidence of anaphylaxis was also high, suggesting that ongoing patient education on allergen avoidance and accidental exposure is imperative.

Assessment of parental self-efficacy in managing child food-induced anaphylaxis and using adrenaline autoinjectors

BACKGROUND

Anaphylaxis is a life-threatening allergic reaction, associated with mental health burden in patients and caregivers. Intramuscular adrenaline via autoinjector (AAI) is the recommended treatment for the management of anaphylaxis in non-hospital settings; however, AAIs are underused. This study aimed to assess parental self-efficacy in managing child's anaphylaxis and administering AAI to understand how to effectively support families.

METHODS

Seventy-five parents of children with severe food allergy completed a questionnaire to measure parental self-efficacy in managing child food-induced anaphylaxis (PSEMA). We conducted an exploratory factor analysis with 12 items, using principal axis factoring as the extraction method. We used Cronbach's alpha to assess the internal consistency of the factors. We used the Anderson-Rubin approach to estimate the factors' scores and provide a kernel density estimate of their distributions. An assessment through linear regression between the total factors' score and total score was performed.

RESULTS

A five-factor model was identified. The factors that emerged were conceptually related to "F1. Manage Injection," "F2. Manage AAI Device," "F3. Manage Anaphylaxis," "F4. Manage Emergency," and "F5. Manage Emotions." The questionnaire demonstrated high internal consistency, with a Cronbach's alpha of 0.91 (95% CI: 0.87-0.94) The variation in the total score explained 90% of the variation in the factor score.

CONCLUSIONS

The PSEMA questionnaire promises to be an easy and effective tool for measuring parents' self-efficacy in managing anaphylaxis and AAI, allowing clinicians to identify gaps in education and provide effective training.

Seeking Care for Children with Intellectual and/or Developmental Disabilities in the Emergency Department: A Mixed Methods Systematic Review of Parents' Experiences and Information Needs

The objective of this review was to explore parents' experiences and information needs regarding management of their child with an intellectual and/or developmental disability (IDD) in the emergency department (ED). We searched six electronic databases and grey literature to identify primary studies in English published since 2000. We synthesized quantitative and qualitative outcome data simultaneously using a convergent integrated approach and used a Mixed Methods Appraisal Tool (MMAT) to assess methodological quality of the included studies. Nine articles derived from seven studies were included (3 qualitative, 3 quantitative, 1 mixed method). Four main themes related to parents' self-reported experiences were identified: 1) appropriateness of the ED to manage and support their child; 2) acknowledgement/recognition of their child's IDD and incorporation of those considerations into overall care and management; 3) managing and navigating the ED environment; and 4) decision to disclose their child's condition when visiting the ED. Two articles provided data relevant to information needs, highlighting parents' desire to have resources supporting ED orientation and access to services within and outside of the ED setting. From the limited number of studies, it was evident that parents wanted better communication with healthcare providers and a greater understanding by ED staff around physical space settings needed to support their child. Resources supporting ED staff and parents to communicate effectively and work together can ensure that children with IDDs care needs are met. Further research into understanding parents' experiences and information needs related to managing a child with an IDD in the ED is needed to guide the development of effective resources.

Impact of Reaction Setting on the Management, Severity, and Outcome of Pediatric Food-Induced Anaphylaxis: A Cross-Sectional Study

BACKGROUND

Prompt epinephrine autoinjector (EAI) use is the primary treatment for anaphylaxis. However, limited Canadian data exist on the impact of reaction location on EAI use for food-induced anaphylaxis (FIA).

OBJECTIVE

We sought to investigate the setting, management, and severity of pediatric FIA.

METHODS

We recruited children presenting with FIA from 11 Canadian emergency departments. Patient demographics and the setting, management, and symptoms of FIA were collected by standardized questionnaire. Factors associated with prehospital EAI use and reaction severity were determined by logistic regression.

RESULTS

We recruited 3,604 children; 60.2% were male and the median age was 5.0 years (interquartile range 1.8-11.0). Among cases with a known location of FIA (85.0%), home was the most common setting (68.1%), followed by school/daycare (12.8%), other locations (11.4%; eg, park, car), and restaurants (7.4%). In the prehospital setting, EAI was administered in 36.7% of reactions at home, 66.7% in school/daycare, 40.2% in other locations, and 44.5% in restaurants. Relative to reactions occurring at school/daycare, prehospital EAI use was less likely at home (adjusted odds ratio [aOR] 0.80; 95% CI 0.76-0.84), in restaurants (aOR 0.81; 95% CI 0.75-0.87), and in other settings (aOR 0.77; 95% CI 0.73-0.83), when data were adjusted for reaction severity, sex, age, comorbidities, and province. The FIA setting was not associated with reaction severity or hospitalization.

CONCLUSIONS

Prehospital EAI use was higher at school/daycare than in other settings, potentially owing to the presence of policies and training on FIA. Setting-specific interventions including educational programs and policies/laws mandating training and stocking an EAI may improve anaphylaxis recognition and treatment.