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J Allergy Clin Immunol Pract. 2018 Sep - Oct;6(5):1559-1567. doi: 10.1016/j.jaip.2018.01.019. Epub 2018 Feb 3.

Value of a Second Dose of Epinephrine During Anaphylaxis: A Patient/Caregiver Survey.

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Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Wash. Electronic address:
Xcenda, AmerisourceBergen Corp, Palm Harbor, Fla.
Allergopharma GmbH & Co KG, Reinbek, Germany.
Section of Allergy/Immunology, University of Tennessee College of Medicine, Memphis, Tenn.



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.


To evaluate real-world use of EAIs and understand the patients'/caregivers' adherence to guidelines.


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.


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.


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.


Allergies; Anaphylaxis; Epinephrine; Epinephrine autoinjector; Health care utilization; Treatment guidelines

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