An audit of the use of self-administered adrenaline syringes in the east end of Glasgow

Abstract

Sir, We were interested to read the recent article by Sabroe et al.1 We had become increasingly aware that some patients prescribed self‐administered adrenaline syringes (EpiPen®; ALK‐Abello, Hungerford, U.K.) did not have adequate information about their usage, and an audit of patients' comprehension was therefore undertaken. We identified 32 adults (> 18 years) attending our clinic who had been prescribed EpiPen®. An unsupervised questionnaire survey among these patients was carried out, and 20 (62·5%) of the 32 patients completed the questionnaire. There was a female preponderance (60%), as observed by Sabroe et al. The median age of our patients was 33·5 years (range 18–51), which was lower than that of the cohort of patients of Sabroe et al. (mean 42 years, range 13–67). The greatest number (n = 8, 40%) of our patients belonged to the 31–40‐year age group. Six of 20 patients (30%) had used EpiPen®, which was lower than the figure of 50% reported by Sabroe et al. Four of the 20 (20%) had to use EpiPen® between two and six times a year, and one each (5%) had used it once a year and more than six times a year. Eighteen of the 20 patients (90%) always carried the device with them. Nine patients (45%) were prescribed one EpiPen®, 10 patients (50%) two, and one patient (5%) had more than two EpiPen®s at one time. Most EpiPen®s were prescribed by general practitioners (n = 11, 55%), followed by allergy specialists (n = 5, 25%), dermatologists (n = 3, 15%) and a consultant in a dental hospital (n = 1, 5%). The indications for EpiPen® prescription were anaphylaxis in 10 (50%), latex allergy in three (15%), angio‐oedema, urticaria and peanut allergy in two (10%) patients each and a combination of anaphylaxis and angio‐oedema in one (5%) patient. Only seven patients (35%) knew to use EpiPen® both for severe wheeze and for throat/tongue swelling. Eight patients (40%) thought to use it only in the circumstances of throat/tongue swelling and one patient (5%) felt to use it only for severe wheeze. In addition, two patients (10%) would use it for hives/urticaria and two (10%) in mild wheeze. Fourteen patients (70%) could remember that the use of EpiPen® was explained and demonstrated to them either by the doctor or nurse, and a comparable figure of 71% was obtained by Sabroe et al. Six (30%) patients claimed to have received no explanation or demonstration of EpiPen®. In this group, three (50%) were prescribed EpiPen® by their general practitioners, and one each (17%) by a dermatologist, allergy specialist and dental hospital consultant. Six patients (30%) did not receive any information leaflet on the correct usage of EpiPen®. Two (10%) patients claimed to have received no explanation, demonstration of EpiPen® or information leaflet but neither patient had had to use the device. It was reassuring that all patients knew to inject EpiPen® into the thigh. Eighteen patients (90%) were not aware of any medications they should be cautioned about if using EpiPen®. Eight (44%) of them had asthma and two (11%) had raised blood pressure. Eighteen patients (90%) had no idea regarding adverse effects of EpiPen®. When they were asked what to do after using an EpiPen®, 16 patients (80%) stated that they would attend the nearest Accident and Emergency department, while three patients (15%) thought it would be better to take it easy and relax and one patient (5%) felt she ought to see her general practitioner. Fourteen (70%) patients were quite happy with information they had received but 10 of them (71%) were still interested to receive more information about EpiPen®.