Published online: March 25, 2019
Anaphylaxis is a severe and potentially life-threatening allergic reaction. It can occur very quickly, with symptoms presenting within minutes of exposure to an allergen, which include food, medication, and venom/insect stings. As such, prompt treatment is critical, and guidelines recommend that at-risk patients always carry epinephrine auto-injectors (EAIs) in case of an anaphylaxis emergency. However, previous studies have shown that patients don’t consistently carry their EAI device and some don’t use their device even when it is available.
In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Portnoy et al. surveyed patients and parents/guardians of patients who filled a prescription for one of two EAIs: EpiPen or Auvi-Q. Both devices deliver a single dose of epinephrine by injection but vary in their shape, size, and instructions. Participants were asked to describe how often they carried their EAI device in the 7 days prior to taking the survey, how confident they were in using it, and how much training they received on the device.
Two thousand people, including adults and children, were included in this survey—half in the Auvi-Q group and half in the EpiPen group. Differences in patient characteristics between the Auvi-Q and EpiPen groups were taken into consideration for statistical testing. Overall, people who were prescribed Auvi-Q were nearly two times more likely to carry their EAI device all the time during the last 7 days compared with those prescribed EpiPen. Results were statistically significant when analyzing all patients, as well as when analyzing adults and children separately. Compared with EpiPen, adults in the Auvi-Q group were more than twice as likely to feel “very confident” about correctly using their EAI on themselves and about someone else correctly using their EAI. There were no significant differences between the Auvi-Q and EpiPen groups regarding parent/guardian responses for feeling “very confident” using the device on their children. Finally, Auvi-Q patients were 3 times more likely to feel that instructions provided with the EAI were “very clear” compared with EpiPen patients.
To summarize, this large, real-world survey found that Auvi-Q respondents were more likely to carry their EAI all the time during the last 7 days and rate device instructions as very clear, and adult patients with Auvi-Q had higher confidence in device use versus EpiPen respondents. Understanding the factors that influence patient behavior regarding carrying compliance and confidence in EAI use could help improve the likelihood of a patient having his/her epinephrine auto-injector available in case of a life-threatening allergic emergency.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.