When is a child ready to begin taking responsibility for anaphylaxis management?

Published Online: April 4, 2013

Pediatric allergists individualize the timing of transferring responsibilities for anaphylaxis recognition and treatment from adults to children and teenagers based on patient readiness. A prior study reported that pediatric allergists typically expected transfer to begin between ages 9-11 years for anaphylaxis recognition and between ages 9-14 years for anaphylaxis treatment. The perspective of parents and caregivers of children and teenagers at risk for anaphylaxis in the community has not been previously investigated.

In a recent issue of The Journal of Allergy and Clinical Immunology: In Practice, Simons et al describe a caregiver-completed questionnaire regarding the optimal time to begin transferring responsibilities for anaphylaxis recognition and treatment to children and teenagers. The questionnaire was completed voluntarily by parents and caregivers attending Food Allergy & Anaphylaxis Network conferences.

319 parents and caregivers of children or teenagers with anaphylaxis participated. The most common ages selected for beginning to transfer responsibilities were: <6 years for describing anaphylaxis symptoms (56.5% of caregivers), 6-8 years for recognizing the need for self-injectable epinephrine (40.2%), demonstrating epinephrine self-injection using a trainer (40.5%) and carrying self-injectable epinephrine (33.7%), and 9-11 years for learning to self-inject epinephrine (41.5%), using a live auto-injector to practice (43.1%), and self-injecting epinephrine (38.4%). Parents and caregivers rated a child's or teenager's history of severe/life-threatening anaphylaxis (95.9%), anaphylaxis triggered by an allergen (such as peanut) known to cause fatality (91.4%), and ability to describe reasons to inject (89.8%) and demonstrate technique with a trainer (89.7%) as ”very important” readiness factors. They commented on the need to individualize timing and on unique situations (such as minimal supervision during lunch time at school) necessitating early transfer of responsibilities.

Parents and caregivers expected transfer of responsibilities to begin between ages <6-8 years for anaphylaxis recognition and between ages 6-11 years for anaphylaxis treatment, younger age ranges than chosen by pediatric allergists. Like the allergists, they individualized timing depending on the child. Further studies are needed to find ways to assess when an individual child is ready to begin taking some responsibility for managing anaphylaxis.


The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

AAAAI - American Academy of Allergy Asthma & Immunology