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Canadian educational levels related to epinephrine autoinjector prescription odds

Less than half of surveyed Canadians with a diagnosed food allergy, particularly in households with lower educational levels, reported having an epinephrine autoinjector prescription in a recent study.

Researchers conducted a random telephone survey in 2010-2011 to target low-income households, new Canadians and aboriginal-identified people. Predictors of being prescribed or always carrying an epinephrine autoinjector (EAI) among people with diagnosed food allergy were identified through multivariate logistic regression.

Survey results were recorded for 5,734 households, representing 15,022 individuals (45% response rate). Diagnosed food allergy was reported by 348 participants; 44% (95% CI, 38.7%-49.4%) were prescribed an EAI, and 56.9% of those respondents indicated they always carried it (95% CI, 48.6%-64.8%).

There was a higher likelihood of being prescribed an EAI among adults with higher education level and children residing in a household with an adult having a post-secondary degree (OR=3.3; 95% CI, 1.69-6.44) and people who reported aboriginal identity (OR=2.5; 95% CI, 1.09-5.75). Patients with peanut or tree nut allergies (OR=3.01; 95% CI, 1.75-5.17), those who had their most severe reaction at a younger age (OR=0.98; 95% CI, 0.96-0.99) and respondents who reported confirmatory testing (OR=3.44; 95% CI, 1.58-7.48) also were more likely to have been prescribed an EAI.

“This is the first study … to examine prescription and availability of the EAI using a population-based survey that targeted vulnerable populations,” the researchers concluded. “We found that many Canadians with food allergy are not prescribed an EAI, particularly adults with lower educational level and children residing in households with low educational attainment; furthermore, almost half those prescribed the device do not carry it.

“All participants reported having been diagnosed by a physician as having food allergy, and 74.4% of those not prescribed an EAI reported having positive diagnostic test results for food allergy. Hence, in most cases, the physician appears to have confirmed the allergy but did not prescribe the EAI.”

Disclosure: The researchers report no relevant financial disclosures.