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Dreborg, S., Tsai, G. & Kim, H. (2019). Implications of variation of epinephrine auto-injector needle length. Annals of Allergy, Asthma & Immunology, 123(1), 89-94
Open this publication in new window or tab >>Implications of variation of epinephrine auto-injector needle length
2019 (English)In: Annals of Allergy, Asthma & Immunology, ISSN 1081-1206, E-ISSN 1534-4436, Vol. 123, no 1, p. 89-94Article in journal (Refereed) Published
Abstract [en]

Background: The variation of needle lengths of epinephrine auto-injectors (EAIs) has not been investigated. Objective: To investigate the impact of the variation of the needle length of EAIs. Methods: Skin-to-muscle (STMD) and skin-to-bone distances (STBD) were measured for 303 children and adolescents and 99 adults. Distance was determined by ultrasound, applying high or low pressure on the probe. The risk of subcutaneous and periosteal/intraosseous injection was calculated using the lower and upper acceptance limits for length of EAI needles as provided for 3 high-pressure EAIs (HPEAI) and 1 low-pressure EAI (LPEAI). Results: The variation in needle length of the HPEAIs are for Epipen Jr/Epipen 5 mm, for Jext 2 mm, for Auvi-Q 2.5 mm, and for the LPEAI, Emerade, 1.5 mm. When using the longest acceptable needles for Epipen Jr, the risk of intraosseous/periosteal penetration was highest in children weighing less than 15 kg at 60% and for Jext at 43%. The risk was low for Auvi-Q and Emerade. The risk of subcutaneous injection was greatest with the shortest needles of the Auvi-Q 0.1 mg at 94% in children weighing less than 15 kg. In adults, the risk of subcutaneous injection using the shortest needles was for Epi-Pen at 41%, Jext at 36%, Auvi-Q at 38%, and Emerade at 12%. Conclusion: The variation in needle length of EAIs influences the risk of subcutaneous and intraosseous/periosteal injections. Compared with Epipen Jr, the Auvi-Q 0.1 mg for children weighing less than 15 kg had a low risk of intraosseous/periosteal injection but a very high risk of subcutaneous injection. For adults, there is a significant risk of subcutaneous injection. (C) 2019 Published by Elsevier Inc. on behalf of American College of Allergy, Asthma & Immunology.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-390802 (URN)10.1016/j.anai.2019.04.027 (DOI)000472823700014 ()31071440 (PubMedID)
Available from: 2019-08-19 Created: 2019-08-19 Last updated: 2019-08-19Bibliographically approved
Wheatley, L. M., Wood, R., Nadeau, K., Liu, A., Zoratti, E., Bacharier, L., . . . Togias, A. (2019). Mind the gaps: Clinical trial concepts to address unanswered questions in aeroallergen immunotherapy-An NIAID/AHRQ Workshop. Journal of Allergy and Clinical Immunology, 143(5), 1711-1726
Open this publication in new window or tab >>Mind the gaps: Clinical trial concepts to address unanswered questions in aeroallergen immunotherapy-An NIAID/AHRQ Workshop
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2019 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 143, no 5, p. 1711-1726Article in journal (Refereed) Published
Abstract [en]

The Agency for Healthcare Research and Quality and the National Institute of Allergy and Infectious Diseases organized a workshop to develop trial concepts that could improve the use and effectiveness of aeroallergen immunotherapy (AAIT). Expert groups were formed to accomplish the following tasks: (1) propose a study design to compare the effectiveness and safety of subcutaneous versus sublingual AAIT; (2) propose a study design to compare the effectiveness and safety of AAIT by using 1 or a few allergens versus all or most allergens to which a patient is sensitized; (3) propose a study design to determine whether AAIT can alter the progression of childhood allergic airways disease; and (4) propose a study design to determine the optimal dose and duration of AAIT to achieve maximal effectiveness with acceptable safety. Study designs were presented by the workgroups, extensively discussed at the workshop, and revised for this report. The proposed trials would be of long duration and require large highly characterized patient populations. Scientific caveats and feasibility matters are discussed. These concepts are intended to help the development of clinical trials that can address some of the major questions related to the practice of AAIT for the management and prevention of allergic airways disease.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2019
Keywords
Aeroallergen, immunotherapy, asthma, allergic rhinitis, rhinoconjunctivitis, multi-allergen, prevention
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-383843 (URN)10.1016/j.jaci.2019.01.032 (DOI)000466784600005 ()30731123 (PubMedID)
Available from: 2019-05-27 Created: 2019-05-27 Last updated: 2019-05-27Bibliographically approved
Dreborg, S. & Kim, H. (2019). Tissue compression and epinephrine deposition [Letter to the editor]. Journal of Allergy and Clinical Immunology: In Practice, 7(6), 2096-2097
Open this publication in new window or tab >>Tissue compression and epinephrine deposition
2019 (English)In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 7, no 6, p. 2096-2097Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Immunology in the medical area Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-390433 (URN)10.1016/j.jaip.2019.03.038 (DOI)000473777600070 ()31056448 (PubMedID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically approved
Cardona, V., Demoly, P., Dreborg, S., Kalpaklioglu, A. F., Klimek, L., Muraro, A., . . . Hoffmann, H. J. (2018). Current practice of allergy diagnosis and the potential impact of regulation in Europe. Allergy. European Journal of Allergy and Clinical Immunology, 73(2), 323-327
Open this publication in new window or tab >>Current practice of allergy diagnosis and the potential impact of regulation in Europe
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2018 (English)In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 73, no 2, p. 323-327Article in journal (Refereed) Published
Abstract [en]

In the European Union (EU), the regulatory framework regarding diagnostic allergen extracts is currently in the process of being implemented at the national level. Due to these regulations, the initial and periodic renewal expenses for the registration of diagnostic allergen extracts may render extract production unprofitable. Consequently, many extracts may be at risk of removal from the market. The current survey, which was conducted by a task force of the European Academy of Allergy and Clinical Immunology, aimed to assess the current practice of allergy diagnosis in Europe. This survey revealed that skin tests continue to be the main diagnostic procedure and are used as the first option in almost two-third of all types of allergic diseases and in 90% of individuals suffering from respiratory allergies. Therefore, there is a need to ensure the availability of high-quality allergen extracts to maintain the common diagnostic procedures used by EU professionals. To reach this goal, it is necessary to align efforts and establish active partnerships between manufacturers, relevant scientific societies, consumer organizations and authorities to maintain the availability of these diagnostic tools.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
allergen extracts, allergy diagnosis, regulation, skin tests
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-341562 (URN)10.1111/all.13306 (DOI)000419871000005 ()28905404 (PubMedID)
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-02-12Bibliographically approved
Dreborg, S., Kim, L., Tsai, G. & Kim, H. (2018). Epinephrine auto-injector needle lengths: Can both subcutaneous and periosteal/intraosseous injection be avoided?. Annals of Allergy, Asthma & Immunology, 120(6), 648-653
Open this publication in new window or tab >>Epinephrine auto-injector needle lengths: Can both subcutaneous and periosteal/intraosseous injection be avoided?
2018 (English)In: Annals of Allergy, Asthma & Immunology, ISSN 1081-1206, E-ISSN 1534-4436, Vol. 120, no 6, p. 648-653Article in journal (Refereed) Published
Abstract [en]

Background: Epinephrine should be administered intramuscularly in the anterolateral aspect of the thigh. The length of the epinephrine auto-injector (EAI) needle should ensure intramuscular injection.

Objective: To discuss suitable EAI needle lengths based on ultrasound measurements related to weight. Methods: The skin-to-muscle distance (STMD) and skin-to-bone distance (STBD) were measured by ultrasound in the mid-third of the anterolateral area of the right thigh when applying high pressure (8 lb; high-pressure EAI [HPEAI]) or low pressure (low-pressure EAI [LPEAI]) on the ultrasound probe. The study included 302 children and adolescents and 99 adults. The maximum and minimum STMD and the maximum and minimum STBD were estimated.

Results: Using HPEAIs, the risk of periosteal or intraosseous penetration was 32% in children weighing less than 15 kg. The risk of subcutaneous injection was 12% in adolescents and 33% in adults. With LPEAIs, there was no risk of periosteal or intraosseous injection and the risk of subcutaneous injections in adolescents and adults was lower at 2% and 10%, respectively. A new EAI for injection in small children would have no risk of periosteal or intraosseous injection but would have 71% chance of subcutaneous deposit of epinephrine.

Conclusion: Common HPEAIs have a high risk of periosteal or intraosseous penetration in children and subcutaneous injections in overweight and obese adults. LPEAIs have some risk of subcutaneous injection in adults. HPEAIs with 0.1 mg of epinephrine and shorter needles have no risk of periosteal or intraosseous injection but have a high risk of subcutaneous deposit. For adult or overweight or obese patients, HPEAIs and LPEAIs should have longer needles. Future studies should focus on triggering pressures and variations in needle length. 

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-358163 (URN)10.1016/j.anai.2018.02.028 (DOI)000434951500017 ()29499370 (PubMedID)
Available from: 2018-12-04 Created: 2018-12-04 Last updated: 2018-12-04Bibliographically approved
Dreborg, S. (2018). Methodological cutoff of basophil activation test and basophil activation test diagnostic value [Letter to the editor]. Journal of Allergy and Clinical Immunology: In Practice, 6(3), 1089-1090
Open this publication in new window or tab >>Methodological cutoff of basophil activation test and basophil activation test diagnostic value
2018 (English)In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 6, no 3, p. 1089-1090Article in journal, Letter (Other academic) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-358423 (URN)10.1016/j.jaip.2017.10.038 (DOI)000432461800068 ()29747973 (PubMedID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Dreborg, S. & Kim, H. (2018). Pressure, trigger forces, and epinephrine auto-injectors Response [Letter to the editor]. Annals of Allergy, Asthma & Immunology, 121(5), 644-645
Open this publication in new window or tab >>Pressure, trigger forces, and epinephrine auto-injectors Response
2018 (English)In: Annals of Allergy, Asthma & Immunology, ISSN 1081-1206, E-ISSN 1534-4436, Vol. 121, no 5, p. 644-645Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Immunology in the medical area
Identifiers
urn:nbn:se:uu:diva-369942 (URN)10.1016/j.anai.2018.09.456 (DOI)000448665400033 ()30389088 (PubMedID)
Available from: 2018-12-18 Created: 2018-12-18 Last updated: 2018-12-18Bibliographically approved
Epstein, T. G., Calabria, C., Cox, L. S. & Dreborg, S. (2017). Current Evidence on Safety and Practical Considerations for Administration of Sublingual Allergen Immunotherapy (SLIT) in the United States. Journal of Allergy and Clinical Immunology: In Practice, 5(1), 34-40
Open this publication in new window or tab >>Current Evidence on Safety and Practical Considerations for Administration of Sublingual Allergen Immunotherapy (SLIT) in the United States
2017 (English)In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 5, no 1, p. 34-40Article, review/survey (Refereed) Published
Abstract [en]

Liquid sublingual allergen immunotherapy (SLIT) has been used off-label for decades, and Food and Drug Administration (FDA)-approved grass and ragweed SLIT tablets have been available in the United States since 2014. Potentially life-threatening events from SLIT do occur, although they appear to be very rare, especially for FDA-approved products. Practice guidelines that incorporate safety precautions regarding the use of SLIT in the United States are needed. This clinical commentary attempts to address unresolved issues including controversy regarding the FDA mandate for the prescription of epinephrine autoinjectors for patients on SLIT; how to approach polysensitized patients; optimal timing and duration of SLIT administration; how to address gaps in therapy; whether antihistamines can prevent local reactions, if certain patient populations (such as persistent asthmatics) should not receive SLIT; and when to instruct patients to self-administer epinephrine. Key points are that physicians should focus on educating patients regarding: (1) when not to administer SLIT; (2) how to recognize a potentially serious allergic reaction to SLIT; and (3) when to administer epinephrine and seek emergency care.

Keywords
Sublingual immunothrapy, adverse drug reaction
National Category
Respiratory Medicine and Allergy
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-320015 (URN)10.1016/j.jaip.2016.09.017 (DOI)000396493400004 ()27815065 (PubMedID)
Available from: 2017-04-12 Created: 2017-04-12 Last updated: 2017-04-28Bibliographically approved
Dreborg, S., Wen, X., Kim, L., Tsai, G., Nevis, I., Potts, R., . . . Kim, H. (2017). Erratum to: Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?. Allergy, Asthma & Clinical Immunology, 13, Article ID 33.
Open this publication in new window or tab >>Erratum to: Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?
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2017 (English)In: Allergy, Asthma & Clinical Immunology, ISSN 1710-1484, E-ISSN 1710-1492, Vol. 13, article id 33Article in journal (Refereed) Published
Abstract [en]

This corrects the article DOI: 10.1186/s13223-016-0110-8

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-341407 (URN)10.1186/s13223-017-0205-x (DOI)28694830 (PubMedID)
Available from: 2018-02-08 Created: 2018-02-08 Last updated: 2018-02-22Bibliographically approved
Dreborg, S. (2016). Cow's milk protein allergy and common gastrointestinal symptoms in infants. Acta Paediatrica, 105(3), 253-254
Open this publication in new window or tab >>Cow's milk protein allergy and common gastrointestinal symptoms in infants
2016 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 3, p. 253-254Article in journal, Editorial material (Refereed) Published
Abstract [en]

In their review on the management of functional gastrointestinal disorders and cow's milk protein allergy (CMPA) in infants (1), Vandenplas et al discuss infantile colic, regurgitation and constipation and the relationship between these symptoms, which are common in infants, to CMPA. The group starts by stating that CMPA can only be diagnosed by a double blind placebo controlled food challenge. However, this can be replaced by an open challenge in infants as long as the challenge is performed under the supervision of an experienced team (2, 3). The authors acknowledge that sensitisation to cow's milk indicates possible CMPA and the need for a challenge to reach a proper diagnosis of CMPA. But then they make some some statements that I feel blur the message (1).

National Category
Pediatrics Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-270721 (URN)10.1111/apa.13311 (DOI)000370247700013 ()26666845 (PubMedID)
External cooperation:
Available from: 2016-01-03 Created: 2016-01-03 Last updated: 2017-12-01Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3544-1557

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