Factors contributing to underuse of epinephrine autoinjectors in pediatric patients with food allergy

Abstract

Background: Epinephrine autoinjectors (EAs) are the standard of care for severe food allergic reactions, although they are frequently underused or misused. Objective: To understand the factors associated with underuse of EA by caregivers of pediatric patients with food allergy. Methods: A survey was administered to 200 caregivers of pediatric patients with food allergies to assess most severe lifetime allergic reaction, EA education, and use and factors associated with incorrect use or underutilization. Results: A total of 164 surveys were completed; of which 118 (72%) of lifetime most severe reactions warranted EA use, but the EA was used in only 45 (38.1%). Reasons caregivers indicated for not administering the EA included the following: reactions did not seem severe enough; it was the patient's first allergic reaction; use of other medication; and fear of using EA. Conclusion: Multiple factors contribute to underuse of EA in the treatment of severe allergic reactions. Results from this study highlight the need for continuous EA education in caregivers of and pediatric patients with food allergies, using a multipronged approach targeting clear symptom recognition and alleviation of fear of EA use.

Management of Children With Food-Induced Anaphylaxis: A Cross-Sectional Survey of Parental Knowledge, Attitude, and Practices

“…Results are in line with previous researches ( 11 – 19 ) and support the importance of investigating the reasons why parents do not act properly in case of anaphylaxis. A recent study involving 164 caregivers ( 17 ) reported that the majority did not give their allergic children AAI at the time of their most severe allergic reactions, despite declaring confidence in their ability to treat allergic reactions. Reasons caregivers indicated for not administering the AAI included the following: reactions did not seem severe enough; use of other medication; and fear of using AAI.…”

“…A study involving 165 parents reported that parental empowerment directly correlated with increased comfort with AAI use, but knowledge did not ( 16 ). Other researches ( 3 , 11 , 17 ) found that the most common reasons among parents for not using adrenaline despite carrying was concern about adverse effects, fear about the injection, and not wanting to activate emergency services or go to the emergency department.…”

“…Parents reported Theoretical-practical courses on AAI use for parents as main help and Written available instructions . This underscores the need for continued focus on educating patients and caregivers to recognize signs and symptoms of anaphylaxis, understanding the role of different allergy medications and effectively using AAI ( 17 ). Many participants suggested Psycho-education/Psychological support for better dealing with the emotional aspects of anaphylaxis management (e.g., fear/anxiety, stress) and a limited number reported Parent support groups to share experiences.…”

Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects

“…New pharmacological therapies in the management of food allergies aim at regulating inducing cells and suppressing the native and adaptive responses responsible for triggering allergic reactions [65][66][67]. These therapies are not allergen-dependent, acting nonspecifically, which differentiates them from immunotherapy.…”

Peanut anaphylaxis in 2022: Decoupling epinephrine usage from emergency department evaluation

“…Recent publications identify this barrier to epinephrine use, citing avoidance of the ED during the COVID-19 pandemic as a factor in up to 20% of anaphylaxis cases in which epinephrine is not used. 8,9 This effect is likely to be observed during cases in which anaphylaxis symptoms are mild or subjective and when caregivers are inexperienced in recognizing symptoms or fearful of epinephrine self-administration. In addition, such an effect may be disparately observed among those patients already burdened by certain socioeconomic determinants of health, including financial strain, possibly widening health care disparities.…”