When should self-injectible epinephrine be prescribed for food allergy and when should it be used?
OBJECTIVE
To explore why epinephrine autoinjectors have failed to prevent fatal food anaphylaxis and how this problem might be solved.


RESULTS
Autoinjectors cannot save lives when they are used too late, misused, not carried, or when an inadequate dose is absorbed; food allergy-induced asthma may not respond when asthma management is suboptimal. New markers for severe reactions have been published.


CONCLUSIONS
The fallibility of autoinjectors means that in the management of food allergy, their provision must take second place to accurate identification of the trigger foods, optimal avoidance, and optimal treatment of other medical conditions that make reactions more dangerous.
Pumphrey
Richard Sh
RSh
Manchester Royal Infirmary, Manchester, UK. richard.pumphrey@nhs.net
D004304:Dosage Forms; D016503:Drug Delivery Systems / Q000009:adverse effects / Q000295:instrumentation; D011307:Drug Prescriptions; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects*; D005512:Food Hypersensitivity / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D010353:Patient Education as Topic; D011788:Quality of Life; D012651:Self Medication / Q000009:adverse effects* / Q000523:psychology / Q000706:statistics & numerical data*
D004304:Dosage Forms; D004837:Epinephrine