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Epinephrine autoinjectors not used in nearly 80% of anaphylactic events
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ORLANDO, Fla. — Many parents of children who require allergy treatment with epinephrine autoinjectors do not regularly use the product during an anaphylactic event, according to research presented at the AAP National Conference & Exhibition. A significant number of these parents were too scared or emotional to administer the potentially life-saving drug when needed, researchers said.
Julie Wang, MD , professor of pediatrics in the division of allergy and immunology at the Icahn School of Medicine at Mount Sinai, and colleagues added that correct epinephrine autoinjector use among Americans with anaphylaxis is relatively uncommon — between 16% and 32%.
“Underuse of epinephrine to treat severe allergic reactions continues to be an important area to address with patients and their families,” Wang told Infectious Diseases in Children. “Identifying barriers to treating severe allergic reactions will allow targeted education, interventions to optimize management of allergic reactions or both.”
To better understand the barriers to correct autoinjector use, Wang and colleagues created a survey that was distributed to caregivers of children who received allergy treatment at a hospital-based pediatric allergy clinic and a faculty practice pediatric allergy clinic. The survey gathered information on the child’s allergy history and their most recent experience with epinephrine autoinjectors.
Of the 137 surveys collected, 77% were completed by mothers and 23% were completed by fathers of children with an average age of 7.435 years. More than half of these patients (68%) were male.
Most parents (78.5%) reported that autoinjectors were not used during their child’s allergic reactions. The most common reason for not using epinephrine was that the reaction did not seem severe enough to warrant epinephrine use (40.3%). Other reasons included that it was their child’s first allergic reaction and no epinephrine was prescribed at the time (33.1%) or other medications — including diphenhydramine — were used instead (27.4%).
The researchers said 18.5% of parents reported being too scared or emotional to administer an epinephrine autoinjector to the child.
“Pediatricians should ensure that families of children at risk for anaphylaxis are prepared with epinephrine autoinjectors because allergic reactions can occur unexpectedly, and the severity of reactions are unpredictable,” Wang said. “Pediatricians should also discuss with families the situations when epinephrine would be needed, provide written emergency plans and address any concerns families may have related to identifying symptoms and use of medications to empower families to initiate prompt treatment for allergic reactions.” – by Katherine Bortz
Reference:Glassberg B, et al. Factors affecting use and misuse of epinephrine autoinjectors in pediatric patients. Presented at: AAP National Conference & Exhibition; Nov. 2-6, 2018; Orlando, Fla.
Disclosure: Wang reports no relevant financial disclosures.
Perspective
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Edwin Kim, MD
The findings reported by Glassberg and colleagues highlight some key deficiencies in our current care model. For years, allergists have quoted data suggesting that fatal food reactions occur primarily in patients with previously known food allergy. This study is a reminder that although this may be true for fatal food reactions, clearly initial reactions can still be severe. One-third of patients in this survey had a severe reaction that warranted epinephrine, but patients did not have access to an autoinjector. The introduction of epinephrine in schools has been a good first step, but it would be important to open the discussion of access to epinephrine more broadly.
The second critical deficiency is the incorrect use of epinephrine by caregivers. Although not a new finding, it is a stark reminder that misconceptions of anaphylaxis and epinephrine continue to prevail. That 40% of caregivers did not feel symptoms — despite being severe — warranted epinephrine, or that 27% of caregivers gave secondary medications, demonstrates the continued difficulty in properly educating people about epinephrine use. Expert guidelines on anaphylaxis (ie, from the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network), while statistically accurate, can be difficult even for medical providers to follow and are thus unusable for most laypeople.
A concerted effort toward demystifying epinephrine use is needed. Emphasizing its safety would be a start, but even showing what the needle looks like, how quickly it infuses and how a patient feels after injection would be helpful. The ultimate intervention would be a patient simulation that recreates the scene of an allergic reaction, the decision to use epinephrine and the life-saving results of its use. Ask any patient who has used epinephrine, and invariably, that patient is far more likely to use it again in the future.
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