Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Wash.
Xcenda, AmerisourceBergen Corp, Palm Harbor, Fla.
J Allergy Clin Immunol Pract. 2018 Sep-Oct;6(5):1559-1567. doi: 10.1016/j.jaip.2018.01.019. Epub 2018 Feb 3.
Anaphylaxis guidelines recommend prescription of more than 1 epinephrine autoinjector (EAI) for patients at risk. A second epinephrine dose is required in 16% to 36% of patients.
To evaluate real-world use of EAIs and understand the patients'/caregivers' adherence to guidelines.
We collected survey responses from US patients and caregivers with an EAI prescription in November 2015. The survey covered several domains relevant to anaphylaxis and EAI use.
The survey was completed by 953 respondents (505 patients and 448 caregivers). Most respondents were women (71%). Most of the respondents had previously administered an EAI (75%). The mean age of the respondents was 28 ± 14.0 years. A total of 786 (82%) respondents did not carry 2 EAIs all the time, and the main reason given was to have 1 EAI in another location. Most respondents kept at least 1 EAI at home (84%). The percentages of respondents with more than 1 EAI available at locations surveyed were low (patients: 22% at home, 2% at work; caregivers: 27% at home, 10% at school). During training, most respondents (64%) were instructed to always carry 1 EAI and keep the other in another location. Half of the respondents reported the use of a second epinephrine dose in a previous event. Forty-five percent of the 73 respondents who sought emergency care did so because of the unavailability of a second dose.
Our study suggests poor adherence in patients and caregivers to anaphylaxis guidelines recommending more than 1 EAI available at all times and implies that this can result in adverse outcomes.
过敏反应指南建议为有风险的患者开不止一支肾上腺素自动注射器（EAI）。有 16%至 36%的患者需要使用第二剂肾上腺素。
评估 EAI 的实际使用情况并了解患者/照护者对指南的遵循情况。
我们于 2015 年 11 月收集了有 EAI 处方的美国患者和照护者的调查回复。该调查涵盖了与过敏反应和 EAI 使用相关的几个领域。
该调查由 953 名受访者（505 名患者和 448 名照护者）完成。大多数受访者为女性（71%）。大多数受访者之前曾使用过 EAI（75%）。受访者的平均年龄为 28 ± 14.0 岁。共有 786 名（82%）受访者并非一直携带 2 支 EAI，主要原因是 1 支 EAI 在另一个地方。大多数受访者至少在家中存放 1 支 EAI（84%）。在接受调查的地点，有超过 1 支 EAI 备用的受访者比例较低（患者：家中 22%，工作场所 2%；照护者：家中 27%，学校 10%）。在培训期间，大多数受访者（64%）被指示始终携带 1 支 EAI，并将另一支存放在另一个地方。一半的受访者报告在之前的事件中使用了第二剂肾上腺素。在寻求紧急护理的 73 名受访者中，有 45%是因为无法获得第二剂而寻求紧急护理。
我们的研究表明，患者和照护者对指南的遵循情况不佳，指南建议始终备有不止一支 EAI，但这可能导致不良后果。
