title: Timing the transfer of responsibilities for anaphylaxis recognition and use of an epinephrine auto-injector from adults to children and teenagers: pediatric allergists' perspective.
abstract: BACKGROUND
  The optimal time for transferring responsibilities for anaphylaxis recognition and epinephrine auto-injector use from adults to children and teenagers has not yet been defined.
  
  
  OBJECTIVE
  To determine whether pediatric allergists have age-specific goals for beginning to transfer responsibilities for anaphylaxis recognition and epinephrine auto-injector use from parents and caregivers to children and teenagers at risk of anaphylaxis in the community.
  
  
  METHODS
  Members of the American Academy of Pediatrics Section on Allergy and Immunology (AAP-SOAI) were surveyed about when they typically begin to transfer these responsibilities from adults to children and teenagers.
  
  
  RESULTS
  Eighty-eight allergists responded to the survey, 97.7% of whom provided service to children and teenagers with food allergies. Few allergists expected to begin transferring responsibilities for anaphylaxis recognition and epinephrine auto-injector use to children younger than 9 to 11 years. By the time their patients reached age 12 to 14 years, however, most allergists expected them to be able to describe some anaphylaxis symptoms (95.4%), demonstrate how to use an epinephrine auto-injector trainer (93.1%), begin carrying self-injectable epinephrine (88.2%), recognize the need for epinephrine (88.1%), learn to self-inject epinephrine (84.5%), and be able to self-inject epinephrine (78.6%) (cumulative data). The allergists rated the following as "very important" readiness factors for beginning to transfer responsibilities: medical history, developmental level, and ability to demonstrate auto-injector technique.
  
  
  CONCLUSIONS
  Most pediatric allergists expected that by age 12 to 14 years, their patients should begin to share responsibilities with adults for anaphylaxis recognition and epinephrine auto-injector use; however, they individualized the timing based on assessment of patient readiness factors.
authors.affiliation: Child Health Evaluative Sciences, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. lmcniven@hsc.mb.ca
authors.forename: Elinor
authors.initials: E
authors.lastname: Simons
authors.forename: Scott H
authors.initials: SH
authors.lastname: Sicherer
authors.forename: F Estelle R
authors.initials: FE
authors.lastname: Simons
mesh_terms: D000293:Adolescent; D000322:Adrenergic Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000486:Allergy and Immunology; D000707:Anaphylaxis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control*; D002648:Child; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005512:Food Hypersensitivity / Q000188:drug therapy; D019538:Health Care Surveys; D006801:Humans; D007273:Injections, Intramuscular; D010372:Pediatrics; D010820:Physicians / Q000523:psychology*; D012648:Self Care; D013997:Time Factors; D014163:Transfer, Psychology; D055815:Young Adult
chemical_list: D000322:Adrenergic Agonists; D004837:Epinephrine