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Prescriptions for adrenaline devices in children are rising faster than anaphylaxis

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1283 (Published 14 March 2017) Cite this as: BMJ 2017;356:j1283
  1. Zosia Kmietowicz
  1. The BMJ

Researchers have called for clarity on when adrenaline auto injectors (AAIs) should be prescribed for children with allergies and how many devices they should be given after finding that prescriptions have been rising faster than the incidence of anaphylaxis.

The doctors and health economists from the University of Birmingham identified 23 837 children in a general practice database as being at high risk of anaphylaxis and scrutinised the prescriptions they were given between 2000 and 2012. They reported the results in the British Journal of General Practice.1

They found that these children were prescribed a total of 98 737 AAIs over the study period, equating to 19.4 devices per 100 person years (95% confidence interval 19.2 to 19.5). About half the children (12 000) were recorded by their GP as having previous anaphylaxis or egg, nut, seafood, or insect venom allergy.

The data showed that over the course of the 12 year study period the proportion of children in the community issued with AAI devices rose by 355%, the proportion of AAI devices prescribed in the community rose by 506%, and the number of devices issued per child rose by 33%, from 3.23 to 4.30.

On average, each child received 3.84 devices during the study period, and the researchers calculated that the proportion of children receiving four or more devices rose from 41% between 2000 and 2006 to 54% between 2007 and 2012.

They extrapolated their data to show that the annual expenditure on AAIs for children in the UK was approximately £6.9m (€7.9m; $8.4m) in 2012. The cost of prescribing AAIs to children could “escalate considerably” if the number of children given these devices continued to rise, they said, while the role of AAIs in managing anaphylaxis “is not very clear.” Although research has indicated that early administration of adrenaline can reduce the need for it in hospital and reduce likelihood of hospital admission, fatalities occur despite early use. Advice on how many devices children should be prescribed is conflicting, and training on how they should be used is often lacking.

Because of the increasing prescription of AAIs and these uncertainties the authors argued for “robust discussion on the rational prescribing of AAI devices.” They added, “Indications for AAI prescription among children and the optimal number of devices that can be issued per child need to be clarified. This will not only have implications for the wellbeing of patients at risk of anaphylaxis but can be cost saving to the NHS.”

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