{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:15:28Z","timestamp":1789398928472,"version":"build-2803163510"},"reference-count":55,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T00:00:00Z","timestamp":1762041600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The recommended first\u2010line treatment for anaphylaxis in the community is intramuscular injection of adrenaline. The treatment is a standardised dose of either a 150\u2009\u03bcg or a 300\u2009\u03bcg adrenaline auto\u2010injector (AAI) device depending upon the patient's weight. Currently, no standardised mechanisms exist to transition patients onto the higher 300\u2009\u03bcg dose when they reach 25\u201330\u2009kg (depending upon the manufacturer).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We undertook analysis of NHS prescriptions data dispensed in the community in England to identify rates of non\u2010standard AAI dose prescribing. Non\u2010standard prescribing is defined as patients who are likely to have exceeded the 25\u201330\u2009kg threshold but still received a 150\u2009\u03bcg dose. Data were limited to the most recent AAI prescription for an individual patient that occurred in the last 2\u2009years (December 2022\u20132024). Patient weight at the time of prescribing was approximated using an age\u2010to\u2010weight correlation model. AAI recommended switching weights, based on device metadata, were compared to the patients' approximated weight to identify non\u2010standard prescribing. Statistical comparison between rates of non\u2010standard prescribing and patient deprivation was computed using Kendall's Tau correlation coefficient. A complementary analysis to identify patients who received a 300\u2009\u03bcg dose but were likely under the 25\u201330\u2009kg threshold was also carried out.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 46,999 patients were identified as having received a 150\u2009\u03bcg strength injector in their most recent AAI prescription; of these, over 95% received two or more devices in line with national guidance. Estimates based on age for weight growth centiles show that between 9480 (20.2%) and at least 1747 (3.7%) of those prescribed a 150\u2009\u03bcg autoinjector were likely to exceed the weight threshold for this dose. Using a Resuscitation Council UK guideline of age 6\u2009years for switching to a 300\u2009\u03bcg dose, the estimated proportion prescribed a non\u2010standard AAI dose increases to 23,059 patients (49.1%). Estimated rates of non\u2010standard AAI prescribing were found to be higher in areas of England with the most deprivation. Conservative estimates found only 67 children likely under 25\u2009kg and 330 children likely under 30\u2009kg who received a 300\u2009\u03bcg dose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This analysis of community AAI prescriptions in England suggests that underdosing of AAI prescriptions in children and adults is not uncommon. Healthcare professionals with patients at risk of anaphylaxis should review whether patients prescribed AAI devices have the appropriate device for their weight.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cea.70163","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T06:24:51Z","timestamp":1762151091000},"page":"30-40","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Adrenaline Auto\u2010Injector Prescribing in Primary Care in England: An Analysis of Non\u2010Standard Dosing"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8229-154X","authenticated-orcid":false,"given":"Louise J.","family":"Michaelis","sequence":"first","affiliation":[{"name":"Newcastle Upon Tyne Hospitals NHS Foundation Trust  Newcastle Upon Tyne UK"},{"name":"Population Health Sciences Institute Newcastle University  Newcastle Upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2404-322X","authenticated-orcid":false,"given":"Thomas","family":"Owen","sequence":"additional","affiliation":[{"name":"NHS Business Services Authority  Newcastle Upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2511-7654","authenticated-orcid":false,"given":"Andrew D.","family":"Bright","sequence":"additional","affiliation":[{"name":"Newcastle Upon Tyne Hospitals NHS Foundation Trust  Newcastle Upon Tyne UK"},{"name":"Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital  Gateshead UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Sherwin\u2010Robson","sequence":"additional","affiliation":[{"name":"NHS Business Services Authority  Newcastle Upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,2]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2025.01.021"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.waojou.2020.100472"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.12272"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2014.10.021"},{"key":"e_1_2_13_6_1","unstructured":"\u201cAnaphylaxis: Assessment and Referral After Emergency Treatment \u201d(2011) NICE CG134 www.nice.org.uk."},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.15675"},{"key":"e_1_2_13_8_1","unstructured":"\u201cRCUK: Emergency Treatment of Anaphylaxis. 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