For your peds & FP docs

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getting a copy of the articles (links to article at end of message).
AAP: Provide Emergency Plan for Children with Severe Allergies
-Epinephrine should also be used as first-line anaphlyaxis tx
/ by  Molly Walker

A child at risk of anaphylaxis should have a prescription for an epinephrine
autoinjector for use in a community setting, as well as a written allergy
and anaphylaxis plan at the beginning of each school year, wrote Julie Wang,
MD, and colleagues for the AAP Section on Allergy and Immunology.

Writing in "Pediatrics", they offered guidance about when a clinician should
provide a written emergency plan for a child with known allergies who may be
at risk of anaphylaxis, such as those reactive to foods or insect stings.

The AAP provided a sample plan for clinicians, which includes a photo of the
child, along with the child's medical history, medication and dosing
instructions, as well as pre-printed guidance about what constitutes a
severe or mild allergic reaction.

The plan also provided information about whether or not the child can
self-carry or self-administer medications. While no specific guidelines
exist, the authors noted that one survey of the AAP Section on Allergy and
Immunology found that most pediatric allergy specialists expect children 9
to 11 years of age to self-carry epinephrine autoinjectors and be able to
self-administer the medication from 12 to 14 years of age.


The second page of the sample plan provides blank space for additional
instructions specific to the child, and includes spaces for emergency
contacts, including healthcare providers, and updated prescription
information for emergency medications. The authors advised that these plans
should be distributed to patients, families, healthcare professionals and


They also addressed the dilemma of epinephrine dosing, as only two fixed
doses of epinephrine autoinjectors exist (0.15 mg and 0.3 mg). While they
noted that 0.15 mg is high for infants and young children, they cited
research that said 80% of pediatricians would prescribe the 0.15 mg
epinephrine autoinjector for an infant or child weighing 22 lbs.

"After consideration of ... alternatives that lead to delay in dosing,
incorrect dosing, or no dose at all and consideration for the favorable
benefit-to-risk ratio of epinephrine in young patients with anaphylaxis,
many physicians recommend the use of the 0.15-mg [epinephrine autoinjector]
in infants," the authors wrote.

They added that it is "reasonable" to recommend epinephrine autoinjectors
with a 0.3 mg dose for those children weighing 55 lbs or more.


Read more here
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--------based on the articles------------

Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan
Pediatrics. epub February 2017 [not yet in PubMed]

Anaphylaxis is a potentially life-threatening, severe allergic reaction. The
immediate assessment of patients having an allergic reaction and prompt
administration of epinephrine, if criteria for anaphylaxis are met, promote
optimal outcomes. National and international guidelines for the management
of anaphylaxis, including those for management of allergic reactions at
school, as well as several clinical reports from the American Academy of
Pediatrics, recommend the provision of written emergency action plans to
those at risk of anaphylaxis, in addition to the prescription of epinephrine
autoinjectors. This clinical report provides information to help health care
providers understand the role of a written, personalized allergy and
anaphylaxis emergency plan to enhance the care of children at risk of
allergic reactions, including anaphylaxis. This report offers a
comprehensive written plan, with advice on individualizing instructions to
suit specific patient circumstances.

Free full-text is available online at:
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Epinephrine for First-aid Management of Anaphylaxis
Scott H. Sicherer, F. Estelle R. Simons, SECTION ON ALLERGY AND IMMUNOLOGY
Pediatrics. epub February 2017  [not yet in PubMed]

Anaphylaxis is a severe, generalized allergic or hypersensitivity reaction
that is rapid in onset and may cause death. Epinephrine (adrenaline) can be
life-saving when administered as rapidly as possible once anaphylaxis is
recognized. This clinical report from the American Academy of Pediatrics is
an update of the 2007 clinical report on this topic. It provides information
to help clinicians identify patients at risk of anaphylaxis and new
information about epinephrine and epinephrine autoinjectors (EAs). The
report also highlights the importance of patient and family education about
the recognition and management of anaphylaxis in the community. Key points
emphasized include the following: (1) validated clinical criteria are
available to facilitate prompt diagnosis of anaphylaxis; (2) prompt
intramuscular epinephrine injection in the mid-outer thigh reduces
hospitalizations, morbidity, and mortality; (3) prescribing EAs facilitates
timely epinephrine injection in community settings for patients with a
history of anaphylaxis and, if specific circumstances warrant, for some
high-risk patients who have not previously experienced anaphylaxis; (4)
prescribing epinephrine for infants and young children weighing <15 kg,
especially those who weigh 7.5 kg and under, currently presents a dilemma,
because the lowest dose available in EAs, 0.15 mg, is a high dose for many
infants and some young children; (5) effective management of anaphylaxis in
the community requires a comprehensive approach involving children,
families, preschools, schools, camps, and sports organizations; and (6)
prevention of anaphylaxis recurrences involves confirmation of the trigger,
discussion of specific allergen avoidance, allergen immunotherapy (eg, with
stinging insect venom, if relevant), and a written, personalized anaphylaxis
emergency action plan; and (7) the management of anaphylaxis also involves
education of children and supervising adults about anaphylaxis recognition
and first-aid treatment.

* Abbreviations:AAP - American Academy of Pediatrics
  EA - epinephrine autoinjector
  EMS - emergency medical services
  IM - intramuscular(ly)

Free full-text is available online at:
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