Supervised Self-Injection Practice Improves Patient Comfort Level with Epinephrine Use

ATLANTA, GA—Supervised self-injection practice in the clinic to simulate adolescents’ use of an epinephrine auto-injector to manage food allergy anaphylaxis offers immediate improvements in patients’ comfort levels, according to research presented at the 2017 AAAAI Annual Meeting.

Self-injection using an empty syringe in the clinic “improved adolescents’ and parents’ comfort level with self-injecting during an anaphylactic reaction,” reported lead study author Christine D’Urso, of the Department of Psychology at Fordham University, in Bronx, NY, and colleagues. “It may translate into substantial clinical benefits when the actual need arises.”  

The study team randomly assigned 60 adolescents, aged 13–17.5 years, and their parents to be instructed in and to perform self-injection or to a control group that was only given instructions on self-injection. Patients had no past history of epinephrine auto-injector use. The patients were assessed both post-injection as well as 1 month later. 

The primary outcome of the study was “self-reported comfort level with the injection before vs. after the intervention on a Likert scale with scores of 1 (not comfortable) to 10 (extremely comfortable).” Secondary outcomes studied were reports of patient anxiety before and after injection, between-group comparisons, quality of life changes, and anxiety experienced post-injection to one month later.

Self-reported comfort levels were significantly and immediately improved (6.93 vs. 8.37 mean score before and after self-injection, P<0.01), the team reported. Results also found a patient was more willing to self-inject after the intervention (7.10 vs. 8.13 mean score before and after self-injection, P<0.01). The authors noted that no changes in the control group were observed. 

“Exploratory between-group analyses showed no significant differences between groups at one month follow-up, but all measures consistently improved in the intervention group only,” the authors reported. Data also found that of the pairs in the intervention group, 83% of children and 88% of parents believed the intervention was beneficial, while 70% of children and 88% of adults stated it improved self-injection ability. The study authors also reported that helpfulness mean Likert scores were 7.0 for adolescents and 8.2 for parents. 

Epinephrine self-injection is key to timely management of food allergy-triggered anaphylaxis but many teens are unsure of their ability to use an auto-injector when the need arrives. Results of the study found that supervised self-injection does improve a patient’s comfort level. The study authors cautioned, however, that “the results are limited to willing participants in a referral population. Impact on anxious potential participants unwilling to assent to the study, and generalizability to other settings, remains to be determined, as well as the real-world impact on self-injection following the intervention.”