AAAAI 2009: Half of Physicians Fail to Prescribe EpiPen for Patients With History of Anaphylaxis

Martha Kerr

March 19, 2009

March 19, 2009 (Washington, DC) — A new study reported here at the 2009 American Academy of Asthma, Allergy and Immunology (AAAAI) Annual Meeting reveals that half of physicians fail to give their patients with a history of anaphylaxis a prescription for auto-injectable epinephrine (EpiPen, Dey LP), and a significant number do not know how to use the devices themselves.

Findings from a study of 43 residents and 7 attending physicians practicing or training in New York City were presented by Irene Paek, MD, an allergy and immunology fellow at Long Island College Hospital, in Brooklyn, New York.

Dr. Paek interviewed the physicians about their experiences prescribing the EpiPen.

Twenty-eight (56%) reported that they knew how to use an EpiPen. They were then asked to demonstrate their technique and were scored on their ability to properly administer epinephrine to themselves.

Only 1 physician was able to perform all of the delivery steps correctly. The average score was 1.39 out of a possible 4.

Seventy percent (35 physicians) of the participants reported having had a patient with anaphylaxis. However, only 51.4% (18 physicians) prescribed an EpiPen to these patients.

Of the 48.6% (17 physicians) who did not prescribe an EpiPen, 7 "didn't think to prescribe it," and 8 chose not to because anaphylaxis was secondary to a known agent, such as a drug or radiocontrast medium, and could therefore be controlled, Dr. Paek told Medscape Allergy & Clinical Immunology. The remaining 2 physicians gave other reasons.

Although 82.0% (41 physicians) thought they knew when to prescribe an EpiPen, only 50% (25 physicians) had ever done so. Of these 25 physicians, only 44% (11 physicians) actually instructed their patients how to use it.

That means that only 11 of the 50 physicians in the study had discussed the use of an EpiPen with their patients who had a history of anaphylaxis, Dr. Paek said.

"Despite most physicians' comfort with prescribing an EpiPen, it is often underprescribed in patients with anaphylaxis," Dr. Paek told meeting attendees. "Further, although many physicians feel they know how to use an EpiPen, this study revealed most physicians are unable to demonstrate its proper usage."

"Only 1 in 10 patients with anaphylaxis is referred to an allergist for follow-up evaluation. And the data show that only 10% to 20% of those are given a prescription for an EpiPen," confirmed Clifford W. Bassett, MD, chair of pubic education for the AAAAI and director of Allergy and Asthma Care of New York, in New York City, in an interview with Medscape Allergy & Clinical Immunology after Dr. Paek's presentation.

"Even when the patient is given a prescription, which happened only half the time in this study, we know that is not good enough," Dr. Bassett said. "We have to follow-up with the patient to make sure the prescription is filled and then we have to teach the patient how to use the device. That means we have to know how to use them.

"We are also finding that a lot of physicians don't know that anaphylaxis is often biphasic," Dr. Bassett added. "A second surge can occur 6 to 24 hours later that can require hospitalization. A half-hour or hour or so of observation after using an EpiPen is not a reasonable amount of time. . . . These patients need to be observed for a day or so and they need to have an EpiPen with them."

Dr. Paek and Dr. Bassett have disclosed no relevant financial relationships.

2009 American Academy of Asthma, Allergy and Immunology (AAAAI) Annual Meeting: Poster 165. Presented March 15, 2009.

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