title: Prevention of Anaphylaxis: The Role of the Epinephrine Auto-Injector.
abstract: Anaphylaxis is a life-threatening condition, with at-risk individuals remaining at chronic high risk of recurrence. Anaphylaxis is frequently underrecognized and undertreated by healthcare providers. The first-line pharmacologic intervention for anaphylaxis is epinephrine, and guidelines uniformly agree that its prompt administration is vital to prevent progression, improve patient outcomes, and reduce hospitalizations and fatalities. Healthcare costs potentially associated with failure to provide epinephrine (hospitalizations and emergency department visits) generally exceed those of its provision. At-risk patients are prescribed epinephrine auto-injectors to facilitate timely administration in the event of an anaphylactic episode. Despite guideline recommendations that patients carry 2 auto-injectors at all times, a significant proportion of patients fail to do so, with cost of medicine cited as one reason for this lack of adherence. With the increase of high-deductible healthcare plans, patient adherence to recommendations may be further affected by increased cost sharing. The recognition and classification of epinephrine as a preventive medicine by both the US Preventive Services Task Force and insurers could increase patient access, improve outcomes, and save lives.
authors.affiliation: Family Medicine, UCLA School of Medicine, Los Angeles, Calif; The Group Practice Forum, New York, NY. Electronic address: lf@grouppracticeforum.com.
authors.forename: Leonard
authors.initials: L
authors.lastname: Fromer
mesh_terms: D000322:Adrenergic Agonists / Q000008:administration & dosage / Q000191:economics; D000707:Anaphylaxis / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003669:Deductibles and Coinsurance / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D004837:Epinephrine / Q000008:administration & dosage* / Q000191:economics*; D006801:Humans; D006967:Hypersensitivity / Q000150:complications / Q000191:economics; D015994:Incidence; D007273:Injections, Intramuscular / Q000191:economics / Q000295:instrumentation; D010349:Patient Compliance / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D055502:Secondary Prevention / Q000191:economics* / Q000331:legislation & jurisprudence / Q000379:methods; D012646:Self Administration / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
chemical_list: D000322:Adrenergic Agonists; D004837:Epinephrine
keywords: Adherence; Anaphylaxis; Auto-injector; Cost; Epinephrine; Preventive