title: Food-Allergic Adolescents at Risk for Anaphylaxis: A Randomized Controlled Study of Supervised Injection to Improve Comfort with Epinephrine Self-Injection.
abstract: BACKGROUND
  Epinephrine self-injection is a key element in the management of food allergy, yet many adolescents report that they may not be able to use the autoinjector when needed. We hypothesized that supervised self-injection with an empty syringe would increase adolescents' comfort with self-injection.
  
  
  OBJECTIVE
  The objective of this study was to examine the effect of supervised self-injection on self- and parent-reported comfort and anxiety during and after clinic visits in a food allergy center.
  
  
  METHODS
  Sixty adolescent/parent pairs were randomized to self-injection versus control (education only). The predefined primary outcome was a self-reported comfort level with the injection before versus after the intervention on a Likert scale with scores of 1 (Not at all comfortable) to 10 (Extremely comfortable). The primary outcome was evaluated via within-group and between-group analyses. Secondary outcomes included adolescent and parent reports before versus after the injection, and changes in quality of life (QoL) and anxiety a month later.
  
  
  RESULTS
  Self-injection was associated with a significant immediate increase in comfort levels (primary outcome; within-group comparison: mean scores: 6.93 preintervention vs 8.37 postintervention, P < .01; between-group ANOVA: 8.37 vs 6.69, P < .01) and with significant improvements in all other predefined (secondary) measures. On follow-up, QoL improved in 52% of intervention patients as compared with 25% of controls; similar differences were observed for anxiety. Those differences were not statistically significant.
  
  
  CONCLUSIONS
  A self-injection (with an empty syringe) procedure in a clinic setting improves adolescents' and parents' comfort level with self-injecting. It may translate into substantial clinical benefits should self-injection be needed.
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: eyal.shemesh@mssm.edu.
authors.forename: Eyal
authors.initials: E
authors.lastname: Shemesh
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Christine
authors.initials: C
authors.lastname: D'Urso
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Psychology, Fordham University, Bronx, NY.
authors.forename: Christopher
authors.initials: C
authors.lastname: Knight
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Psychology, Fordham University, Bronx, NY.
authors.forename: Melissa
authors.initials: M
authors.lastname: Rubes
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Kinga M
authors.initials: KM
authors.lastname: Picerno
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Ailie M
authors.initials: AM
authors.lastname: Posillico
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Zara
authors.initials: Z
authors.lastname: Atal
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Psychology, Fordham University, Bronx, NY.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Annunziato
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Scott H
authors.initials: SH
authors.lastname: Sicherer
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000209:etiology / Q000517:prevention & control*; D001007:Anxiety / Q000517:prevention & control*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007267:Injections; D008297:Male; D018671:Needle-Exchange Programs; D009934:Organization and Administration; D010290:Parents; D000070659:Patient Comfort / Q000379:methods*; D010353:Patient Education as Topic; D011788:Quality of Life; D012646:Self Administration; D013594:Syringes / Q000706:statistics & numerical data
chemical_list: D004837:Epinephrine
keywords: Anxiety; Epinephrine; Exposure; Food allergy; Self-management