Learning from Epinephrine Treatment Characteristics Among Patients with Severe Allergic Reactions including Anaphylaxis to Improve Professional and Patient Education: Analyses from a US Claims Database

Abstract

Epinephrine is recognized as an important life-saving medication for the emergency treatment of patients with allergic reactions (Type I) including anaphylaxis. To better understand real-world prevalence and treatment characteristics, we sought to analyze US claims database and physician/patient surveys for insights into epinephrine use, particularly the impact that autoinjector non-utilization has on patient care. Claims data was analyzed over a 6-year period (07/2014-06/2019) with patient cohorts selected for the diagnosis having >1 provider visit with ≥1 allergy diagnosis during a 36-month period (07/2016-06/2019). Additionally, surveys were conducted with Physicians (n=75) and Parents/Patients (n=250) exploring prescribing behavior and EAI use. In 2018, <18% of at-risk patients filled prescriptions for EAIs and indicate waiting up to 18 minutes before treatment. Physicians self-report they do not prescribe EAIs in 20% of their patients at risk. Of patients prescribed EAIs, only 45% carry the device consistently, with top reasons for not having an EAI on hand included fear of IM administration, device size, assumed ability to avoid triggers and that devices are available in public locations. Appropriate epinephrine treatment of severe allergic reactions with EAIs are frequently delayed or avoided. When prescribed, EAIs are generally used to treat the most severe symptoms of anaphylaxis. Physicians indicate more patients should utilize epinephrine promptly to immediately address allergic reactions and avoid progression to a life-threatening event. Further patient education is warranted to quickly recognize an allergic reaction and to treat with epinephrine immediately to avert progression to more serious symptoms or shock.