title: Canadian allergists' and nonallergists' perception of epinephrine use and vaccination of persons with egg allergy.
abstract: BACKGROUND
  Studies suggest knowledge gaps about epinephrine use and vaccination of persons with egg allergy.
  
  
  OBJECTIVE
  We compared the perception of Canadian allergists and nonallergists on issues related to epinephrine use and vaccination of persons with egg allergy.
  
  
  METHODS
  Canadian allergists, pediatricians, general practitioners/family physicians and emergency room physicians were recruited through medical associations and surveyed on these issues. Multivariate logistic regression models were used to identify determinants of specific responses.
  
  
  RESULTS
  One-hundred fourteen allergists and 613 nonallergists participated. For most issues with accepted best practices, allergists were more likely to adhere to recommendations. Allergists versus nonallergists were more likely to recommend intramuscular epinephrine for anaphylaxis (odds ratio [OR] = 3.8; 95% CI, 1.43-10.11). Older physicians (OR = 0.98; 95% CI, 0.97-0.99), Canadian-Paediatric-Surveillance-Program participants (OR = 0.48; 95% CI, 0.24-0.96), family physicians (OR = 0.39; 95% CI, 0.16-0.96), and general practitioners (OR = 0.14; 95% CI, 0.04-0.52) were less likely to recommend intramuscular use. However, in severe anaphylaxis, >25% of both groups would not give epinephrine for patients presenting with breathing difficulties or hypotension. Use of epinephrine for severe anaphylaxis was less likely in older physicians (OR = 0.97; 95% CI, 0.95-0.99), female physicians (OR = 0.60; 95% CI, 0.39-0.89), and those practicing in Ontario (OR = 0.56; 95% CI, 0.36-0.86), Manitoba (OR = 0.42; 95% CI, 0.19-0.90), or Nova-Scotia (OR = 0.31; 95% CI, 0.12-0.78). Allergists (OR = 6.22; 95% CI, 3.60-10.72) and physicians treating mainly children (OR = 3.41; 95% CI, 1.87-6.25), or practicing in Quebec (OR = 1.68; 95% CI, 1.12-2.55) were more likely to recommend measles-mumps-rubella vaccination in a community facility.
  
  
  CONCLUSIONS
  Knowledge gaps about mode and indications for epinephrine administration and vaccination policies need to be addressed in future education programs to ensure prompt epinephrine use and to avoid unnecessary restriction of vaccines.
authors.affiliation: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada. Electronic address: marylin.desjardins@mail.mcgill.ca.
authors.forename: Marylin
authors.initials: M
authors.lastname: Desjardins
authors.affiliation: Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Ann
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Reza
authors.initials: R
authors.lastname: Alizadehfar
authors.affiliation: Department of Pediatrics, University of Ottawa, Canadian Paediatric Society, Ottawa, Ontario, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Grenier
authors.affiliation: Montreal Children's Hospital, Emergency Department, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Harley
authors.initials: H
authors.lastname: Eisman
authors.affiliation: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, University of Alberta, Alberta, Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: Carr
authors.affiliation: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, University of Alberta, Alberta, Canada.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Vander Leek
authors.affiliation: Society of Rural Physicians of Canada, Shawville, Quebec, Canada.
authors.forename: Lee
authors.initials: L
authors.lastname: Teperman
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Niamh
authors.initials: N
authors.lastname: Higgins
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.affiliation: Department of Epidemiology, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: Shand
authors.affiliation: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Moshe
authors.initials: M
authors.lastname: Ben-Shoshan
mesh_terms: D000486:Allergy and Immunology / Q000193:education; D000707:Anaphylaxis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D002170:Canada; D002648:Child; D003888:Desensitization, Immunologic / Q000379:methods / Q000592:standards; D021181:Egg Hypersensitivity / Q000188:drug therapy / Q000276:immunology* / Q000517:prevention & control*; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012651:Self Medication / Q000592:standards; D013038:Specialization; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000379:methods / Q000592:standards
chemical_list: D004837:Epinephrine
keywords: Egg allergy and vaccination; Epinephrine autoinjectors; Epinephrine use; Knowledge gaps