Anaphylaxis was first described by Charles Richet and Paul Portier in 1901 as an immune reaction that is the opposite of immune protection resulting from vaccination.Citation1 Anaphylaxis can be better categorized into both immunoglobulin E (IgE) and non-IgE pathways.Citation2 Between 1.6% and 5.1% of the Americans are estimated to experience anaphylaxis, which can be fatal.Citation3 The common triggers for an acute anaphylactic episode are foods, drugs, and venoms. Ultimately, a number of mediators are released that explain the clinical symptoms of flushing, pruritus, urticaria, shortness of breath, bronchospasm, hypotension, and cardiovascular collapse.Citation2 Epinephrine injection is the evidence-based treatment for acute anaphylaxis, and delayed epinephrine administration is a risk factor for fatal anaphylaxis.Citation3 However, like many other effective therapies in medicine, there remain barriers to treatment of anaphylaxis.
This special edition of the Journal of Asthma and Allergy focuses on anaphylaxis from many different provocative angles and should be an asset to practicing physicians. Yue et al focus on food and drug allergies associated with anaphylaxis, an issue that has evolved over the years culminating in new guidelines for the treatment of food allergies, which may impact on the incidence of food-related anaphylaxis.Citation4 Jiminez-Rodriguez et al provide a comprehensive overview of anaphylaxis types and biomarkers.Citation5 Prince et al focus on deficiencies in the proper use of epinephrine.Citation6 Westermann-Clark et al focus on the economics of epinephrine treatment, a topic rarely discussed at annual scientific meetings, but one that is in the lay press quite frequently.Citation7
Previous studies of epinephrine injection use for the treatment of anaphylaxis identified two main areas of obstacles for patients and caregivers: lack of correct use and lack of response.Citation8 Lack of affordability and lack of prescription by physicians were determined to be components for the lack of use of epinephrine injections. Incorrect use and delayed injection were described as reasons for lack of response. Correct use of the devices is often studied through human factors studies, which is paramount to proper treatment of anaphylaxis.Citation9,Citation10 Incorrect use of epinephrine can also result in needle injuries, which have been documented in multiple case reports.Citation11–Citation14 Lack of response to epinephrine can also be due to the malfunction of the device, as noted recently with autoinjectorsCitation15,Citation16.
We hope that the current issue will help clinicians better understand the pathophysiology, diagnosis, and treatment options for anaphylaxis.
Disclosure
The author reports no conflicts of interest in this work.
References
- RingJeditorAnaphylaxis Chem Immunol AllergyBaselKarger2010111
- CastellsMDiagnosis and management of anaphylaxis in precision medicineJ Allergy Clin Immunol1402321333
- TurnerPJJerschowEUmasuntharTLinRCampbellDEBoyleRJFatal anaphylaxis: mortality rate and risk factorsJ Allergy Clin Immunol Pract2017551169117828888247
- YueDCiccoliniAAvillaEWasermanSFood allergy and anaphylaxisJ Asthma Allergy201811111120
- Jiminez-RodriguezTWGarcia-NeuerMAlenazyLCastellsMAnaphylaxis in the 21st century: phenotypes, endotypes and biomarkersJ Asthma Allergy201811121142
- PrinceBTMikhailIStukusDRUnderuse of epinephrine for the treatment of anaphylaxis: missed opportunitiesJ Asthma Allergy201811143151
- Westermann-ClarkEPepperANLockeyRFEconomic considerations in the treatment of systemic allergic reactionsJ Asthma Allergy201811153158
- SimonsKJSimonsFEEpinephrine and its use in anaphylaxis: current issuesCurr Opin Allergy Clin Immunol20101035436120543673
- MossRBDanielsKMollTCarloDJHuman factors study in untrained adolescents comparing an epinephrine prefilled syringe (Symjepi™) with EpiPen® autoinjectorAnnals of Allergy, Asthma & Immunology20181205540541
- MossRBDanielsKMollTCarloDJHuman Factors Study of a Newly Approved Epinephrine Prefilled syringe (PFS) for the Emergency Treatment of Allergic Reactions (Type I) including AnaphylaxisAAAAI MeetingMarch 3; 2018Orlando, FL abstract 124
- SimonsFEREdwardsESReadEJClarkSLiebelELVoluntary reported unintentional injections from epinephrine auto-injectorsJACI2010125419423
- CopelandCJAccidental digital epinephrine injection: to treat or not to treat?Can Fam Physician20146072672825122817
- BrownJRTuri, Lacerations and embedded needles due to Epipen use in childrenJ Allergy Clin Immunol Pract20164354955126897302
- RedmondMStukusDLacerations associated with use of epinephrine autoinjectors in childrenJ Allergy Clin Immunol Pract20164322132218
- ReutersU.S. Mylan says EpiPen manufacturing partner to expand device recall [press release]Health News2017 [April 1]. Available from: http://www.reuters.com/article/us-mylan-nl-recall-epipen/mylan-says-epipen-manufacturing-partner-to-expand-device-recall-idUSKBN1722XBAccessed May 16, 2018
- ReutersU.S. FDA warns of problems with EpiPen manufacturing plant [press release]U.S. Legal News2017 [September 8]. Available from: https://www.reuters.com/article/us-pfizer-mylan-epipen/u-s-fda-warns-of-problems-witepipen-manufacturing-plant-idUSKCN1BI2Y5Accessed May 16, 2018