In a recent review, which was published recently in the journal Clinical & Experimental Allergy, researchers sought to investigate the effectiveness of adrenaline autoinjectors for the prevention of fatal outcomes in anaphylaxis, for which patients with systematic mastocytosis (SM) are known to be at an elevated risk.
The data used derived from animal and human in vivo studies, as well as epidemiologic analyses.
How common is anaphylaxis?
Anaphylaxis is defined as “an acute systemic hypersensitivity reaction to an allergen or trigger.” When anaphylaxis occurs, it usually can be linked to airway, circulatory or respiratory interference. Clinical characteristics, not diagnostic tests, are used to depict the presence of anaphylaxis.
Even though the occurrence of anaphylaxis normally resolves without an individual experiencing any long-term physical effects, this rare event can occur suddenly and can affect a person’s entire body. Thus, when anaphylaxis does occur, it can be associated with anxiety and impairment in an individual’s quality of life.
In rare cases, community anaphylaxis can lead to rapid physical decompensation and even to death. Community anaphylaxis is defined as a life-threatening allergic reaction to such things as drugs, vaccines, food products and bee stings.
In the United States, anaphylaxis is reported in approximately 5% of the population. In contrast, the condition is observed in around 0.5% of European residents.
Read more about SM therapies
What treatments are used in individuals who experience anaphylaxis?
Adrenaline (epinephrine) is the foundation of anaphylaxis therapy. In fact, the utilization of adrenaline autoinjectors is the recognized standard of care among all individuals who are considered to be at risk for the development of anaphylaxis.
Prescription adrenaline autoinjectors (the EpiPen) were approved for use by the US Food and Drug Administration in 1987, with subsequent approvals in Germany in 1989 and the United Kingdom in 1996. The purpose of using adrenaline autoinjectors is for the prevention of fatal anaphylaxis.
Results of both human and animal studies have suggested that the use of intravenous adrenaline infusion, along with appropriate fluid resuscitation, can prevent the occurrence of fatal anaphylaxis. Studies have also been conducted using intramuscular injections of adrenaline, with varying, unpredictable results reported.
What are the advantages and disadvantages of adrenaline autoinjectors?
The utilization of adrenaline autoinjectors presents certain challenges. Among these challenges are availability and access of these devices, patient/caregiver/health care practitioner hesitancy, design of the device and uncertainty regarding the optimal dose to use in cases of anaphylaxis.
Adrenaline autoinjector prescriptions are not always filled by patients. Alternatively, even if the prescriptions have been filled, patients frequently do not carry or use their adrenaline autoinjectors during times of anaphylaxis.
What conclusions can be drawn about the utilization of adrenaline autoinjectors?
“[T]hese data suggest that current [adrenaline autoinjectors] have little impact on rates of fatal anaphylaxis, perhaps due to a lack of sustained and sufficient plasma adrenaline concentration,” the authors explained.
“Effects of [adrenaline autoinjectors] on quality of life may be variable,” they noted. “There is a need to consider alternatives, which can safely deliver a sustained adrenaline infusion via an appropriate route,” they concluded.
