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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.

Author information

1
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Wash. Electronic address: tsong@allergyasthmass.com.
2
Xcenda, AmerisourceBergen Corp, Palm Harbor, Fla.
3
Allergopharma GmbH & Co KG, Reinbek, Germany.
4
Section of Allergy/Immunology, University of Tennessee College of Medicine, Memphis, Tenn.

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.

KEYWORDS:

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

PMID:
29408441
DOI:
10.1016/j.jaip.2018.01.019
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