Study: You’re Likely Not Carrying Your Epinephrine or Using it Early Enough

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This study was scheduled to be presented at the AAAAI 2020 Meeting which was canceled due to COVID-19.

Epinephrine is the only medication that can halt the progression of anaphylaxis, a severe, life-threatening allergic reaction. Early administration of the drug when anaphylaxis is suspected leads to better outcomes, yet many who should be carrying epinephrine auto-injectors (EAIs) and administering them promptly in an emergency are not.

Researchers seeking to understand the scope of the problem turned to a database of US insurance claims and subsequent physician/patient surveys for insights into epinephrine use, particularly the impact that autoinjector non-utilization has on patient care.

Culling data from a six-year period (07/2014-06/2019), the researchers selected a patient cohort of those with two or more provider visits and at least one allergy diagnosis during a 36 month period (07/2016-06/2019). They then sent surveys to 75 physicians and 250 patients/parents to explore prescribing behavior and epinephrine use.

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The results are harrowing:

  • In 2018, fewer than 18% of at-risk patients filled their prescriptions for epinephrine auto-injectors and wait up to 18 minutes before administering the treatment when anaphylaxis was suspected;
  • Physicians self-reported that they do not prescribe EAIs for 20% of their at-risk patients;
  • Of patients who were prescribed EAIs, only 45% carried the device consistently. The top reasons for not carrying the device included fear of administering the epinephrine, the size of the device, their assumption that they could avoid their triggers, and their assumption that the devices would be available in public locations.

Based on their analysis, the researchers concluded:

Appropriate epinephrine treatment of severe allergic reactions with EAIs are frequently delayed or avoided. When prescribed, EAIs are generally used to treat the most severe symptoms of anaphylaxis. Physicians indicate more patients should utilize epinephrine promptly to immediately address allergic reactions and avoid progression to a life-threatening event. Further patient education is warranted to quickly recognize an allergic reaction and to treat with epinephrine immediately to avert progression to more serious symptoms or shock.

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What this means for you

Epinephrine is a life-preserver when the unthinkable happens and you suspect anaphylaxis. Prompt administration can save your life, but only if you have it with you. Here are some takeaways:

  • If you have been diagnosed with a food allergy, insist your provider prescribe an epinephrine auto-injector. If they refuse because your symptoms were relatively mild, consider switching providers as one reaction does not predict the severity of the next;
  • If you have been prescribed an epinephrine auto-injector, take two along everywhere, every time. Why two? Because one may not provide a dose sufficient to halt the progression of anaphylaxis and the second provides a back-up in case the first fails due to user error or manufacturing defect;
  • Administer epinephrine as soon as you suspect anaphylaxis and call 911. Early administration leads to better outcomes, period. You must seek emergency care even if your symptoms subside to ensure you do not have a second (biphasic) reaction;
  • If you fear using an auto-injector, discuss with your physician who may have you practice in their office with a trainer or an empty device.
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