After Pediatric ED Visits for Allergies, Parents Often Don't Keep Epinephrine Devices Handy

By Shawana Alleyne-Morris

May 08, 2020

(Reuters Health) - When children are prescribed self-injectable epinephrine (SIE) in the emergency department, most parents get the prescription filled - but a year later, most of them don't have an unexpired device at hand, a new study finds.

"A majority of pediatric patients in an urban population filled their prescription for SIE, though less than half of them had an unexpired device readily accessible," Dr. William C. Sokoloff of Cohen Children's Medical Center in New Hyde Park, New York and colleagues report in the American Journal of Emergency Medicine.

"The most alarming finding to come out of our study was the number of patients who fill their prescription but then don't properly maintain or carry their devices," Dr. Sokoloff told Reuters Health in an email. "And this is despite many of them already having subsequent allergic reactions."

Using all the phone numbers in each patient's medical record, he and his colleagues attempted to survey the parents or guardians of 170 children under age 18 who received prescriptions for SIE in an urban hospital ED over a 12-month period. The interviewers asked about the nature of the child's allergy, if they possessed an SIE, and its expiration date and accessibility.

Of the 100 adults who responded, 43% were Hispanic, 35% were black, and 5% were white. Sixty-two percent were on public insurance, 33% had private insurance and 2% were uninsured.

Eighty-four parents (84%) had initially filled the SIE prescriptions given to their children. At the time of the phone survey - an average of 14 months later - 65% could prove they had an SIE, but 29% of those were expired. ("Proof" was defined as the ability of the subject to read the expiration date on the device). Only 46% could prove they had an unexpired device.

The cost of SIEs rose by more than 500% from 2006 to 2016, the authors note.

But when the researchers looked at a similar set of children and parents treated at a military medical center, where medications are free, they found there wasn't a significant difference in the prescription filling rate.

Dr. Sokoloff found it, "surprising, but perhaps reassuring," that the fill rates in the urban hospital ED and the military medical center were similar. "Prior research on medication prescription filling rates, particularly from the emergency department, has shown lower filling rates among minority populations and among patients with Medicaid," he said. "As one would hope though, it appears the life-saving nature of an SIE device can overcome these disparities in ways not seen with other medications."

The more severe the reaction that was treated in the ED, the more likely it was that SIE prescriptions would be filled and kept up to date and accessible.

The type of allergy also seemed to play a role in emergency readiness. Compared to children with allergic reactions of unknown etiology, children with food allergies were more likely to have their device available and up to date - most likely because of the risk of re-exposure, the authors say.

"Providers need to understand why their patients don't fill prescriptions for SIE and the most common reason families reported was simply a belief it wasn't actually needed," Dr. Sokoloff said. "Addressing parents' beliefs and the patient's needs is a prime discussion, whether during an ED follow-up visit or during an annual physical exam in the years after the initial prescription was prescribed."

"Patients, providers and hospitals have to change (the way they think about) allergic reactions," he continued. "We can't think of severe allergies as sporadic events; rather we should think of them the way we think about chronic conditions like asthma and diabetes. Follow-up, particularly with a specialist if possible, appears to be the key to improving medication adherence and preparedness for future emergencies."

SOURCE: American Journal of Emergency Medicine, online April 26, 2020.