Published online Mar 9, 2022. doi: 10.5409/wjcp.v11.i2.151
Peer-review started: April 13, 2021
First decision: July 27, 2021
Revised: August 2, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: March 9, 2022
Food allergy is common in the paediatric age group and food allergic reactions commonly occur in the community. The adrenaline auto-injector (AAI), issued to groups of children at risk of anaphylaxis, remains the first and only drug of choice for treating anaphylaxis. However, data from different parts of the world demonstrate that AAI is underused by parents and caregivers. The rationale behind this attitude is multilateral and could be attributed to issues such as poor training on the use of the auto-injector device, not understanding when it should be used, and both fear and anxiety of using it.
From our daily observations in the local paediatric allergy clinic, we found many cases of anaphylaxis that occurred at home due to the ingestion of offending food, and parents opted to call 999 or bring the child to the emergency department rather than using the AAI prescribed at the scene. Obviously, underuse of the AAI can put the affected child at risk of severe morbidity or mortality. In every clinic, we reviewed the indication for use of the AAI by parents and provided a visual demonstration on how to use it.
To study the attitude of parents of children at risk of anaphylaxis with regard to the use of AAI in an attempt to identify what prevents these parents from using the AAI when needed. The results of this research would help professionals to be more focused on certain issues when providing counselling and training on the use of the AAI to this cohort of parents.
Parents of children with previous or potential anaphylaxis who have been issued with an AAI were requested to complete a paper questionnaire on their understanding of the indications for use of the AAI, competence in using the device, confidence and empowerment in using it in stressful emergency situations.
The vast majority of parents admitted receiving good and informative training on using the device and demonstrated good knowledge on its indications. However, that was not enough to provide them with the confidence and courage to use the device due to other factors such as anxiety, fear, or not wanting to hurt the child with the AAI needle. Psychological uneasiness in using the device can limit parents’ ability to use it.
In addition to routine training in these groups of parents on the indication of using the AAI and the technique on how to use it, health professionals need to pay attention to the psychological factor which could prevent these parents from underusing the device when needed. Psychological, behavioural therapy and needle phobia desensitisation would help to overcome the barriers of phobia and anxiety which could interfere with sound decision-making in the treatment of their children in emergency situations.
Parent training on the use of AAI should be structured and focused. Audio-visual tools should be available in the clinic to help with training. However, the fear factor and the psychological status of these parents should not be overlooked. A routine referral or referral of selected cases to the local psychological service should be accessible to these parents. Play therapists can also have an important role in both children and parents by reducing needle phobia when present.