ArticleThe journal of allergy and clinical immunology. In practice
The Emperor Has No Symptoms: The Risks of a Blanket Approach to Using Epinephrine Autoinjectors for All Allergic Reactions.
Article in The journal of allergy and clinical immunology. In practice. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Risk factors for severe reactions in food allergy: Rapid evidence review with meta-analysis.Allergy · 2022Pooled it
- Anaphylaxis.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2024Review
- Who Needs Epinephrine? Anaphylaxis, Autoinjectors, and Parachutes.The journal of allergy and clinical immunology. In practice · 2023Review
- Living with food allergies: the experiences of adult patients and caregivers.Frontiers in allergy · 2023Article
- Inhibition of pathologic immunoglobulin E in food allergy by EBF-2 and active compound berberine associated with immunometabolism regulation.Frontiers in immunology · 2023Article
- Dissemination of EAACI food allergy guidelines using a flexible, practical, whole school allergy awareness toolkit.Allergy · 2021Article
- Ascertainment Bias in Anaphylaxis Safety Data of COVID-19 Vaccines.The journal of allergy and clinical immunology. In practice · 2021Article
- Evidence update for the treatment of anaphylaxis.Resuscitation · 2021Review
- APPEAL-1: A multiple-country European survey assessing the psychosocial impact of peanut allergy.Allergy · 2020Article
- Effects of Intranasal Epinephrine on Cerebrospinal Fluid Epinephrine Pharmacokinetics, Nasal Mucosa, Plasma Epinephrine Pharmacokinetics, and Cardiovascular Changes.Pharmaceutical research · 2020Article
- Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects.Pharmacology research & perspectives · 2020Article
- Myths, facts and controversies in the diagnosis and management of anaphylaxis.Archives of disease in childhood · 2019Review
- Anaphylaxis.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2018Review
- Fatal Anaphylaxis: Mortality Rate and Risk Factors.The journal of allergy and clinical immunology. In practiceReview
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
Fatal anaphylaxis in humans is rare and unpredictable. We note a trend to provide allergic individuals with care plans that recommend immediate use of epinephrine autoinjectors if allergen ingestion is suspected, even in the absence of any allergic symptoms, without any supporting evidence base. Instructions to use an autoinjector device, irrespective of reaction severity and especially when symptoms are actually absent, are likely to add to parental and patient anxiety. Of greater concern is the possibility of epinephrine being administered "too early" to treat initial, mild symptoms that then progress to severe anaphylaxis. It is not hard to visualize a scenario where one or both epinephrine autoinjectors have been deployed for mild symptoms, yet the reaction progresses to a severe reaction and no further epinephrine is available for administration. Epinephrine needs to be available as a rescue treatment for anaphylaxis, potentially buying valuable minutes while emergency medical services are activated to attend. Food-allergic individuals and their carers need to be provided with more constructive strategies and support than merely being told to "use your pen."
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.