First aid anaphylaxis management in children who were prescribed an epinephrine autoinjector device (EpiPen)

Background: Epinephrine for first aid use by parents and other caregivers and in the form of an autoinjector device (EpiPen, Center Laboratories) is often prescribed for children who have had previous anaphylactic reactions. It is not known whether the EpiPen device is used appropriately during subsequent reactions and whether its use is able to prevent the complications of anaphylaxis. Objective: Our purpose was to determine parental knowledge and practice concerning first aid anaphylaxis management, the frequency of recurrent generalized allergic reactions, the first aid measures taken, and the subsequent outcome of these reactions. Methods: A retrospective survey was performed with a telephone questionnaire of all children with a history of anaphylaxis who attended a specialist allergy service and were prescribed an EpiPen autoinjector device. Results: Recurrent generalized allergic reactions occurred with a frequency of 0.98 episodes per patient per year and were more common in those with food compared with insect venom anaphylaxis, The EpiPen device was only used in 29% of recurrent anaphylactic reactions. Parental knowledge was deficient in recognition of the symptoms of anaphylaxis and use of the EpiPen device, and adequate first aid measures were not in place for the majority of children attending school. Those children in whom the EpiPen device was used were less likely to be given epinephrine in hospital and to require subsequent hospital admission. Conclusion: The EpiPen autoinjector device is infrequently used in children with recurrent episodes of anaphylaxis; the reasons for this require further research. It is likely that parents and other caregivers will require continuing education and support in first aid anaphylaxis management. When the EpiPen device is used appropriately, it appears to reduce subsequent morbidity from anaphylaxis.