While discussing my nephew’s egg allergy with my mother-in-law, she said she did not feel confident using his epinephrine auto-injector (EAI) and would feel more comfortable giving Benadryl. This conversation piqued my curiosity and opened my eyes to a population of caregivers who we, as allergists, do not usually have an opportunity to interact with.
We are asking non-medical people who do not attend visits to the allergist to diagnose and treat anaphylaxis with an intramuscular prescription medication. We know that delayed epinephrine use is associated with deaths due to anaphylaxis. However, even physicians do not consistently give epinephrine to treat anaphylaxis. A 2014 study showed that only 8% of patients diagnosed with anaphylaxis in the emergency department received epinephrine.
How can we ask these caregivers to feel comfortable with this daunting task? How do we as allergists prepare families to educate their children’s caregivers about EAI use? There are so many barriers to using EAI: cost, availability, fear, improper technique. What is the best way to communicate with these caregivers who we never meet?
After this conversation, I went straight to the internet to see what resources exist. I was encouraged by the number of articles and videos from allergy organizations and various hospitals demonstrating appropriate use and technique of EAI. However, there are some articles and blogs stating that epinephrine will “result in cardiovascular death” or complaining of the cost increase of EAIs and claiming a conspiracy of overuse. But, the most concerning discovery I found were videos from well-meaning sources showing incorrect EAI technique.
The Food Allergy Research and Education (FARE) website has a 15-minute training course reviewing risks and signs of anaphylaxis. The course includes instructional videos of EpiPen, AuviQ and generic EAI. The course, while lengthy, is thorough and accurate. The FARE website also has an anaphylaxis action plan which can be posted in the home as a quick reference for caregivers. EpiPen, AuviQ and CVS Pharmacy all have quick instructional how-to videos online for proper administration of each EAI, if time is a factor.
Richard Stiehm, MD, FACAAI, UCLA’s professor emeritus, says you don’t know a topic well until you teach it. Since research shows patients forget the proper technique for EAI if they haven’t practiced in three months, we should encourage and enable patients and their families to review proper technique with their caregivers, reinforcing their own knowledge. Yearly reminders at visits are not sufficient. If we empower patients and parents to teach others by providing them with the appropriate resources, everyone benefits.
Christin L. Deal, MD
Senior FIT representative