We know that the sooner epinephrine is administered when anaphylaxis is suspected, the better the outcome, yet many leave their auto-injectors home or delay using them. Why?
One answer is that many adolescents (and their parents) fear using an auto-injector, possibly because they have inadequate training in proper use or because they fear the needle that is deployed when an auto-injector is applied.
Researchers from Mount Sinai conducted a study to see how training would affect anxiety regarding the use of epinephrine auto-injectors. The study included 60 adolescents aged 13-17 diagnosed with a food allergy and who had been prescribed an auto-injector but never used it. Each was accompanied by a parent or guardian during appointments.
“Many adolescent patients with food allergies experience needle phobia or anxiety about self-administering epinephrine,” said the study’s lead author, Eyal Shemesh, MD, Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai. “Although it’s a simple idea for teenagers to practice giving themselves an injection to make themselves feel comfortable, this could lead to them being confident enough to take a life-saving action using epinephrine down the road.”
All the adolescents were given training in the proper use of the auto-injector, while half were given an empty injector afterward and told to self-administer under the supervision of a doctor. Both groups then filled out questionnaires at the end of the training and one month afterward.
The results: 83% of the teenagers and 88% of parents described the training as beneficial while 70% of the youths said the intervention helped improve their ability to self-inject.
The followup showed a 52% improvement in quality of life responses for the youths that received the training and self-injection supervision, while the teens that received the training alone saw a 25% improvement.
We at SnackSafely.com often hear from families that receive a diagnosis of food allergy, are prescribed an epinephrine auto-injector, and are left on their own with little or no instruction in how and when to use it. Instruction that includes practice with an empty injector is rare.
We urge allergists to include such training as part of all diagnoses that require prescription of an auto-injector, and urge parents to insist on such training before leaving the allergists office.
Comfort with the use of an auto-injector will likely lead to earlier administration when anaphylaxis is expected, both by the youth as well as the parent, leading to better outcomes when the unthinkable happens.