Development of a validated, updated North American pediatric food allergy anaphylaxis management plan.

BACKGROUND

Current North American anaphylaxis action plans (AAPs) lack updated anaphylaxis guidelines that conditionally recommend "immediate activation of emergency medical services" after epinephrine use for patients experiencing a "prompt, complete, and durable response" to treatment. This offers a contextualized "watchful waiting" approach. AAPs may not include newly approved nasal epinephrine or differentiate anaphylaxis presentations by age.

OBJECTIVE

To develop an updated AAP.

METHODS

A prototype AAP was iteratively developed incorporating a "watchful waiting" approach, the nasal epinephrine option, and age-specific anaphylaxis symptom presentations among a team of anaphylaxis experts and patient and advocacy stakeholders to assess medical accuracy, readability, clarity, and bias. This underwent validated assessment of decisional acceptability, decisional conflict, and decisional self-efficacy in a sample of stakeholders with children at risk for anaphylaxis, or at risk themselves.

RESULTS

We developed a 2-page written plan (Flesch-Kincaid reading level 5.9) explaining management choices for severe and nonsevere reactions, indications for watchful waiting vs emergency medical services activation after epinephrine use, updated medication options, and age-based symptom differentiation. A total of 229 stakeholders assessed the AAP, noting good acceptability, high decisional self-efficacy (mean score 86.2/100, SD 15.9), and moderate decisional conflict (mean score 43.7/100, SD 18.8). Decisional conflict was unrelated to past anaphylaxis or epinephrine use. Information content was clear and sufficiently explained options with balanced and without a "best choice" bias. Overall, 86% of the respondents would recommend using this AAP.

CONCLUSION

This is the first validated AAP incorporating preference-sensitive post-epinephrine management options consistent with updated North American guidelines, newly approved nasal epinephrine, and age-specific anaphylaxis presentation.