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Development of a validated, updated North American pediatric food allergy anaphylaxis management plan
Aikaterini Anagnostou1, Elissa M Abrams2, William C Anderson3
1Department of Allergy and Immunology, Texas Children's Hospital, Houston, Texas.
Insights
An updated anaphylaxis action plan (AAP) was developed, incorporating watchful waiting and nasal epinephrine. This validated AAP improves patient understanding and decision-making for anaphylaxis management.
Area of Science:
- Allergy and Immunology
- Emergency Medicine
- Patient Education
Background:
- Current North American anaphylaxis action plans (AAPs) lack updated guidelines for post-epinephrine care and newer treatment options.
- Existing AAPs may not address age-specific anaphylaxis presentations or newly approved nasal epinephrine.
Purpose of the Study:
- To develop and validate an updated Anaphylaxis Action Plan (AAP).
- The updated AAP incorporates current guidelines, new medications, and age-specific symptom presentations.
Main Methods:
- Iterative development of a prototype AAP by experts and stakeholders.
- Inclusion of a
- watchful waiting
- approach, nasal epinephrine, and age-specific symptoms.
- Validated assessment of the AAP for medical accuracy, readability, bias, and user decision-making.
Main Results:
- A 2-page AAP was developed with a Flesch-Kincaid reading level of 5.9.
- 229 stakeholders reported good acceptability, high decisional self-efficacy, and moderate decisional conflict.
- 86% of respondents would recommend the updated AAP.
Conclusions:
- This is the first validated AAP integrating preference-sensitive post-epinephrine management options.
- The AAP aligns with updated North American guidelines and includes new treatment modalities.
- The plan addresses age-specific anaphylaxis presentations and newly approved nasal epinephrine.
Background:
Current North American anaphylaxis action plans (AAPs) lack updated anaphylaxis guidelines that conditionally recommend "immediate activation of emergency medical services" after epinephrine use for patients experiencing a "prompt, complete, and durable response" to treatment. This offers a contextualized "watchful waiting" approach. AAPs may not include newly approved nasal epinephrine or differentiate anaphylaxis presentations by age.
Objective:
To develop an updated AAP.
Methods:
A prototype AAP was iteratively developed incorporating a "watchful waiting" approach, the nasal epinephrine option, and age-specific anaphylaxis symptom presentations among a team of anaphylaxis experts and patient and advocacy stakeholders to assess medical accuracy, readability, clarity, and bias. This underwent validated assessment of decisional acceptability, decisional conflict, and decisional self-efficacy in a sample of stakeholders with children at risk for anaphylaxis, or at risk themselves.
Results:
We developed a 2-page written plan (Flesch-Kincaid reading level 5.9) explaining management choices for severe and nonsevere reactions, indications for watchful waiting vs emergency medical services activation after epinephrine use, updated medication options, and age-based symptom differentiation. A total of 229 stakeholders assessed the AAP, noting good acceptability, high decisional self-efficacy (mean score 86.2/100, SD 15.9), and moderate decisional conflict (mean score 43.7/100, SD 18.8). Decisional conflict was unrelated to past anaphylaxis or epinephrine use. Information content was clear and sufficiently explained options with balanced and without a "best choice" bias. Overall, 86% of the respondents would recommend using this AAP.
Conclusion:
This is the first validated AAP incorporating preference-sensitive post-epinephrine management options consistent with updated North American guidelines, newly approved nasal epinephrine, and age-specific anaphylaxis presentation.
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