Real-world data indicate a poor level of adherence to anaphylaxis treatment guidelines regarding the availability of more than one automatic epinephrine injector (EAI) at all times. Findings from the study were published in The Journal of Allergy and Clinical Immunology: In Practice.

Currently, treatment guidelines recommend the prescription of ≥1 EAI for patients at risk for anaphylaxis. For this study, researchers aimed to assess real-world use of EAIs to understand the level of guideline adherence among patients and caregivers. They surveyed U.S. patients and caregivers aged 13 to 65 years old who had received an EAI prescription in November 2015; a total of 505 patients and 448 caregivers responded. 

Three-fourths of the survey respondents had previously administered an EAI. The data indicated 82% did not carry 2 EAIs at all times, mainly due to keeping 1 EAI in another location. Most (84%) respondents said they kept at least 1 EAI at home, however, few patients and caregivers kept >1 EAI (patients: 22% at home, 2% at work; caregivers: 27% at home, 10% at school). 

More than half of the respondents (64%) said they received counseling with an emphasis on always having 1 EAI and keeping another in a different location, but only 27% reported counseling that emphasized always having 2 EAIs available.

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The survey also indicated half of the respondents reported using a second epinephrine dose in a previous event, of which 58% were able to self-administer the second dose. Of those who sought emergency care (n=73), 45% did so because a second dose was unavailable. 

Based on the survey results, the researchers found that compared to patients, caregivers were more likely to always carry 2 EAIs (odds ratio [OR 0.44, 95% CI: 0.23, 0.84). Individuals who received some training on EAI administration (OR 4.06) or always received education (OR 16.85) were more likely to carry 2 EAIs at all times vs individuals who received no education. Moreover, those who previously administered an EAI (OR 3.11, 95% CI: 1.75, 5.53) had a higher chance of carrying 2 EAIs at all times vs those who had not previously administered an EAI. 

“Our study suggests poor adherence in patients and caregivers to anaphylaxis guidelines recommending >1 EAI available at all times and implies that this can result in adverse outcomes,” concluded the authors.

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