For your peds & FP docs -----Original Message----- I thought you might find this interesting. Let me know if you need help 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 [snip] 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. [snip] 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 schools. [snip] 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. [snip] Read more here < http://www.medpagetoday.com/allergyimmunology/allergy/63084 > --------based on the articles------------ Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan Julie Wang, Scott H. Sicherer, SECTION ON ALLERGY AND IMMUNOLOGY 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: < http://pediatrics.aappublications.org/content/early/2017/02/09/peds.2016-400 5 > 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: < http://pediatrics.aappublications.org/content/early/2017/02/09/peds.2016-400 6 > < > (if the URL line breaks be sure to copy everything inside the angle brackets into your browser's address box) If you do not want to receive emails like this reply to this email with the words "delete from list" and I will remove you from my distribution lists. 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