title: Use assessment of self-administered epinephrine among food-allergic children and pediatricians.
abstract: OBJECTIVE
  Food allergy is a common cause of anaphylaxis, and early treatment with epinephrine can be life-saving. We sought to determine the ability of families with food allergic children and pediatricians to properly use self-injectable epinephrine.
  
  
  METHODS
  We enrolled families of consecutive, food-allergic pediatric patients newly referred to our allergy practice but previously prescribed epinephrine and a sampling of pediatricians. Parents or teenage patients answered a structured questionnaire concerning use of self-injectable epinephrine and demonstrated the use of devices with which they were familiar. Demonstrations were scored in a standard manner.
  
  
  RESULTS
  One hundred one families of food-allergic children (mean age of patients, 6.4 years) were enrolled. Self-injectable epinephrine was prescribed (mean of 2.7 years previously) primarily by pediatricians (n = 46) and allergists (n = 49). Patients were prescribed EpiPen (n = 93), EpiE-Z Pen (n = 11), and Ana-Kit (n = 3). Eighty-six percent of the families responded that they had the device with them "at all times," but only 71% of this group had epinephrine at the visit. Among those with the epinephrine, 10% had devices beyond the labeled expiration date. Thus, only 55% of the 101 families had unexpired epinephrine on-hand at the time of the survey. Among children in school, 77% had the medication available in school, and 81% stated that the school knew the indications for administration. Only 32% of the participants correctly demonstrated the use of the device. Twenty-nine attending pediatricians were enrolled (mean 14 yrs in practice; mean 4 epinephrine prescriptions/year). Familiarity with the devices was as follows: EpiPen (86%), EpiE-Z Pen (17%) and Ana-Kit (7%). Only 24% generally gave patients written materials concerning indications. Overall, 18% were familiar with and able to demonstrate correct use of at least 1 device (21% correctly demonstrated Epi-Pen). Seventeen pediatric residents were enrolled; 65% were familiar with the EpiPen; 36% demonstrated it correctly and only 1 resident was familiar with Ana-Kit.
  
  
  CONCLUSIONS
  Many parents of severely food-allergic children, and food-allergic teenagers cannot correctly administer their self-injectable epinephrine and may not have the medication readily available. Pediatricians are not familiar with these devices and may fail to review their use with patients. Improved patient and physician education is needed to ensure proper use of this life-saving medication.
authors.affiliation: Division of Allergy and Immunology, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, New York 10029-6574, USA. scott.sicherer@mssm.edu
authors.forename: S H
authors.initials: SH
authors.lastname: Sicherer
authors.forename: J A
authors.initials: JA
authors.lastname: Forman
authors.forename: S A
authors.initials: SA
authors.lastname: Noone
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D002983:Clinical Competence; D004837:Epinephrine / Q000008:administration & dosage*; D005512:Food Hypersensitivity / Q000188:drug therapy*; D006801:Humans; D007267:Injections / Q000295:instrumentation*; D007396:Internship and Residency; D010290:Parents; D010353:Patient Education as Topic; D010372:Pediatrics / Q000193:education; D012648:Self Care
chemical_list: D004837:Epinephrine