Factors Contributing to Underuse of Epinephrine Autoinjectors in Pediatric Patients With Food Allergy

Abstract

In this study, the researchers evaluate barriers to epinephrine autoinjector (EA) use in the treatment of allergic reactions to food occurring outside of the health care setting.Participants were recruited from a food allergy clinic at Mount Sinai Hospital in New York, New York. Most respondents were mothers (76.8%), with a 4-year college degree or beyond (96.3%) and an annual household income >$150 000 (75.6%). Most patients were male (69.5%), with an average age of 7.5 years.An anonymous survey was distributed to caregivers during a food allergy clinic visit before allergy education. Patients were required to have a physician-diagnosed food allergy and a previously prescribed EA. Data were then analyzed by Pearson’s correlation and Fisher’s χ2 tests.A total of 164 surveys were included in the analysis. All but 1 caregiver-reported previous EA teaching, most of which was done verbally (90.9%), with printed materials (83.5%) and live demonstrations of EA use (81.7%). A total of 95.1% of EA education was done by an allergy specialist, with only 38.4% of reported education by a pediatrician. The majority of caregivers were either “very confident” (43.3%) or “fairly confident” (42.1%) in their ability to use an EA during a severe allergic reaction. On review of reaction history, it was found that 72.0% of reactions were severe and warranted EA administration, but only 38.1% were treated with epinephrine. Lack of EA use was significantly associated with oral antihistamine administration instead (76.7% of responses; P < .001), caregiver feeling that symptoms were not severe enough (47.9%; P = .016), and caregiver fear or nervousness about the reaction (29%; P < .001). Although hives (84.8%) was the most commonly reported symptom in a reaction, only vomiting (41.5%; P < .001), cough (33.5%; P < .001), and shortness of breath (31.1%; P < .001) were significantly associated with EA use. There was no association with lack of EA use during a severe reaction and level of confidence in EA use or method of education.Despite high levels of caregiver confidence in the ability to administer epinephrine, EAs are often underused during severe reactions.There are many barriers to appropriate EA use, even in the setting of a well-educated and previously trained population. Repeated EA teaching focused on symptom recognition, indications for EA use, and emotional preparedness may benefit caregivers of patients with food allergies.