Value of a Second Dose of Epinephrine During Anaphylaxis: A Patient/Caregiver Survey.
The journal of allergy and clinical immunology. In practice · 2018-01-01 · Observational study
Abstract
BACKGROUND: Anaphylaxis guidelines recommend prescription of more than 1 epinephrine autoinjector (EAI) for patients at risk. A second epinephrine dose is required in 16% to 36% of patients. OBJECTIVE: To evaluate real-world use of EAIs and understand the patients'/caregivers' adherence to guidelines. METHODS: We collected survey responses from US patients and caregivers with an EAI prescription in November 2015. The survey covered several domains relevant to anaphylaxis and EAI use. RESULTS: The survey was completed by 953 respondents (505 patients and 448 caregivers). Most respondents were women (71%). Most of the respondents had previously administered an EAI (75%). The mean age of the respondents was 28 ± 14.0 years. A total of 786 (82%) respondents did not carry 2 EAIs all the time, and the main reason given was to have 1 EAI in another location. Most respondents kept at least 1 EAI at home (84%). The percentages of respondents with more than 1 EAI available at locations surveyed were low (patients: 22% at home, 2% at work; caregivers: 27% at home, 10% at school). During training, most respondents (64%) were instructed to always carry 1 EAI and keep the other in another location. Half of the respondents reported the use of a second epinephrine dose in a previous event. Forty-five percent of the 73 respondents who sought emergency care did so because of the unavailability of a second dose. CONCLUSIONS: Our study suggests poor adherence in patients and caregivers to anaphylaxis guidelines recommending more than 1 EAI available at all times and implies that this can result in adverse outcomes.