Value of a second dose of epinephrine during anaphylaxis: a patient/caregiver survey

Publication date: Available online 3 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): T. Ted Song, Duncan Brown, Martin Karjalainen, Ulrike Lehnigk, Phil Lieberman
BackgroundAnaphylaxis guidelines recommend prescription of >1 epinephrine auto-injector (EAI) for patients at risk. A second epinephrine dose is required in 16 to 36% of patients.ObjectiveEvaluate real-world use of EAIs and understand the patients/caregivers' adherence to guidelines.MethodsWe collected survey responses from United States patients and caregivers with an EAI prescription in November 2015. The survey covered several domains relevant to anaphylaxis and EAI use.ResultsThe survey was completed by 953 respondents (505 patients, 448 caregivers). Most respondents were women (71%). The majority of respondents had previously administered an EAI (75%). The mean age was 28 (standard deviation ± 14.0) years. 786 (82%) respondents did not carry 2 EAIs all the time, and the main reason given was to keep 1 EAI in another location. Most respondents kept at least 1 EAI at home (84%). The percentages of respondents with >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. 45% of the 73 respondents who sought emergency care did so because of the unavailability of a second dose.ConclusionOur study suggests poor adherence in patients and caregivers to anaphylaxis guidelines recommending >1 EAI available at all times and implies that this can result in adverse outcomes.