From the Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada.
Division of Allergy and Clinical Immunology, McGill University, Montreal, Quebec, Canada.
Allergy Asthma Proc. 2023 Jan 1;44(1):45-50. doi: 10.2500/aap.2023.44.220073.
Anaphylaxis is the most severe manifestation of a systemic allergic reaction, and, in the community setting, the immediate administration of an epinephrine autoinjector (EAI) can be life-saving. Physicians are tasked with selecting the most appropriate EAI for each individual and counseling patients and/or their caregivers to maximize the likelihood of successful deployment of the EAI. To offer an evidence-based expert clinical perspective on how physicians might best tailor EAI selection to their patients with anaphylaxis. A group of eight adult and pediatric allergists with expertise in anaphylaxis management reviewed and assessed the published data and guidelines on anaphylaxis management and EAI device selection. Personalized EAI selection is influenced by intrinsic individual factors, extrinsic factors such as the properties of the individual EAI (e.g., dose, needle length, overall design) as well as cost and coverage. The number and the variety of EAIs available have expanded in most jurisdictions in recent years, which provide a greater diversity of options to meet the characteristics and needs of patients with anaphylaxis. There currently are no EAIs with customizable dose and needle length. Although precise personalization of each patient's EAI remains an optimistic future aspiration, careful consideration of all variables when prescribing EAIs can support optimal management of anaphylaxis.
过敏反应是全身性过敏反应最严重的表现，在社区环境中，立即使用肾上腺素自动注射器（EAI）可挽救生命。医生的任务是为每个个体选择最合适的 EAI，并对患者和/或其照顾者进行咨询，以最大程度地提高 EAI 成功使用的可能性。为了提供基于证据的专家临床观点，说明医生如何根据过敏反应患者的具体情况选择 EAI。一组具有过敏反应管理专业知识的 8 位成人和儿科过敏症专家审查并评估了过敏反应管理和 EAI 设备选择的已发表数据和指南。个性化 EAI 的选择受到内在个体因素、个体 EAI 的外在因素（例如剂量、针头长度、整体设计）以及成本和覆盖范围的影响。近年来，大多数司法管辖区的 EAI 数量和种类都有所增加，这为满足过敏反应患者的特征和需求提供了更多的选择。目前还没有可定制剂量和针头长度的 EAI。尽管为每个患者的 EAI 进行精确的个性化设置仍然是一个乐观的未来愿望，但在开处方 EAI 时仔细考虑所有变量可以支持过敏反应的最佳管理。
