♦ Robinson M, et al. Ann Allergy Asthma Immu-nol. 2017;119:164-169, http://bit.ly/2v Yj2fe.
Just over one-third of children experiencing anaphylaxis received epinephrine before arriving at the
hospital, according to a new study.
The findings come as prevalence of anaphylaxis
rises and amid recommendations from the Academy ( http://bit.ly/2vcc48T) and others to promptly
treat with epinephrine.
Researchers analyzed records from 408 patients
ages 0-25 years who were treated for anaphylaxis
at Nationwide Children’s Hospital from 2009-’ 13.
They found 36.3% received epinephrine before
arrival. Children were more likely to fall into this
category if they were between the ages of 13 and 17,
had multiple food allergies, had a history of anaphylaxis or had a reaction that occurred at school.
“Treatment with epinephrine is often delayed or
avoided by parents and caregivers, and sometimes
antihistamines are used even though they are not an
appropriate treatment,” lead author Melissa Robinson, D.O., said in a press release.
Another predictor of early epinephrine was the number of organ systems involved. Those whose symptoms
impacted two or three organ systems were less likely
to receive epinephrine prior to arriving at the hospital
than those with one organ system involved. The authors
called it a “very ominous and illogical finding” and said
regional preferences or patient misunderstanding may
have been involved, but more study is needed.
The authors also found about 30% of children
who had been prescribed self-injectable epineph-
rine did not have it with them when the allergic
About half of all patients received epinephrine at
the hospital and were more likely to do so if they
hadn’t already received it. Researchers found patients
were more likely to be discharged home if they had
received epinephrine before arriving at the hospital.
“Ongoing efforts to provide education to patients
and medical care professionals regarding appropriate
and timely recognition of anaphylaxis and prompt
epinephrine are needed,” the authors concluded.
The Academy’s customizable Allergy and Anaphylaxis Emergency Plan is available at www.aap.
by Melissa Jenco • News Content Editor
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American Academy of Pediatrics
P.O. Box 927 • Elk Grove Village, IL 60009-0927
Epinephrine use often delayed for children with anaphylaxis
Immediate amoxicillin deemed most cost-effective
treatment for acute otitis media in children under 2
♦ Shaihk N, et al. J Pediatr. June 28, 2017,
Children under 2 with acute otitis media (AOM)
who haven’t taken antibiotics recently can be treated most cost effectively with amoxicillin, researchers found.
Researchers compared five AOM treatments using a hypothetical cohort of children and data from
previous studies and their own estimates.
Treatments from least effective to most effective
were delayed prescription for antibiotic, watchful
waiting, immediate cefdinir, immediate amoxicillin
and immediate amoxicillin/clavulanate.
Treatments from least costly to most costly
were delayed prescription, immediate amoxicillin,
watchful waiting, immediate amoxicillin/clavulanate and immediate cefdinir.
Watchful waiting and immediate cefdinir were
more expensive and less effective than immediate
amoxicillin so the team did not include them in its
incremental cost-effectiveness ratios (ICER).
They found an ICER of $101.07 per quality-ad-
justed life day gained for giving amoxicillin imme-
diately compared to delaying a prescription. There
was an ICER of $2,331.28 per quality-adjusted
life day gained for giving amoxicillin/clavulanate
immediately compared with giving amoxicillin
The team concluded immediate amoxicillin would
be the most cost-effective strategy while amoxicil-
lin/clavulanate would be a second-line treatment.
Watchful waiting and delaying a prescription could
be wise choices in certain circumstances.
“Given the large number of prescriptions for an-
timicrobial drugs that are written for children with
AOM, it seems likely that improvements in the
diagnostic accuracy of primary care pediatricians
could result in a substantial reduction in the cost
of care for children with AOM,” authors wrote.
About one-third of children did not have their
prescribed self-injectable epinephrine with them
when they had an allergic reaction that sent them
to the hospital, a recent study found.
Children switching to front-
facing car seats too early
♦ Jones AT, et al. J Pediatr. July 13, 2017,
Roughly 38% of 17- to 19-month-olds were
not following AAP recommendations to ride in
rear-facing car seats, according to a new study.
Young children in a forward-facing seat are five
times more likely to be seriously injured than those
in a rear-facing seat. The Academy recommends
children stay in a rear-facing seat until age 2 depending on their height and weight.
To determine how well families follow this recommendation, researchers surveyed 491 caregivers
of 17- to 19-month-old children who had been
discharged from Oregon Health and Science University Mother Baby Unit. All had received anticipatory guidance on newborn care, including a flier
on AAP recommendations for car seats.
They found 62% were using rear-facing car seats.
Many of those families said they did so because it
was safer and recommended. Parents whose children were forward-facing often said their child was
too tall, too heavy or his or her feet were touching
the seat. About 20% of the children were facing
forward at 12 months.
Children were more likely to be rear-facing if
their caregiver was white and non-Hispanic, lived
in an urban area, had a college degree or had a
household income above $100,000, according to
the study. Odds of being rear-facing also increased
if the child’s primary care physician was a pediatrician, if the family recently had discussed car safety
with their physician or if the caregiver was aware
of the AAP recommendations.
Caregivers who had used car seats in the past
were less likely to put their child in a rear-facing
seat. Researchers said this group may have been less
aware of the Academy’s 2011 recommendations.
They encouraged more education about car seat
safety for this group and others.
“Public health efforts should focus on developing effective resources and programs for more
vulnerable or hard-to-reach populations, increasing awareness of AAP’s recommendations among
caregivers, and encouraging primary care providers to discuss car safety seat use during well-child
checks,” they wrote.