Self-administration of adrenaline for anaphylaxis during in-hospital food challenges improves health-related quality of life

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Burrell, Sarah
Patel, Nandinee
Vazquez-Ortiz, Marta
Campbell, Dianne E.
DunnGalvin, Audrey
Turner, Paul J.
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Objective: To assess the impact of anaphylaxis on health-related quality of life (HRQL) and self-efficacy in food-allergic patients undergoing in-hospital food challenge. Design: Secondary analysis of a randomised controlled trial. Setting: Specialist allergy centre. Patients: Peanut-allergic young people aged 8–16 years. Interventions: Double-blind, placebo-controlled food challenge to peanut, with HRQL and self-efficacy assessed using validated questionnaire, approximately 2 weeks prior to and 2 weeks after challenge. Where possible, anaphylaxis was treated with self-injected adrenaline (epinephrine). Main outcome measures: Change in HRQL and self-efficacy. Results: 56 participants had reactions at food challenge, of whom 16 (29%) had anaphylaxis. Overall, there was an improvement in HRQL (mean 2.6 points (95% CI 0.3 to 4.8); p=0.030) and self-efficacy (mean 4.1 points (95% CI 2.4 to 5.9); p<0.0001), independent of whether anaphylaxis occurred. Parents also reported improved HRQL (mean 10.3 points (95% CI 5.9 to 14.7); p<0.0001). We found evidence of discordance between the improvement in HRQL and self-efficacy as reported by young people and that perceived by parents in their child. Conclusions: Anaphylaxis at food challenge, followed by self-administration of injected adrenaline, was associated with an increase in HRQL and self-efficacy in young people with peanut allergy. We found no evidence that the occurrence of anaphylaxis had a detrimental effect. Young people should be encouraged to self-administer adrenaline using their autoinjector device to treat anaphylaxis at in-hospital challenge.
Allergy quality , Double-blind , European Academy , Children , Adolescents , Prevalence , Efficacy , Risk , Questionnaire , Validation
Burrell, S., Patel, N., Vazquez-Ortiz, M., Campbell, D. E., DunnGalvin, A. and Turner, P. J. (2021) 'Self-administration of adrenaline for anaphylaxis during in-hospital food challenges improves health-related quality of life', Archives of Disease in Childhood, 106(6), pp. 558-563. doi: 10.1136/archdischild-2020-319906