PURPOSE OF THE STUDY.
Adolescents with allergies are at high risk of fatal anaphylactic reactions. The current study explores barriers to epinephrine auto-injector use among at-risk adolescents in Scotland and investigates strategies to improve anaphylaxis management.
Twenty-six adolescents aged 13 to 19 years and 28 of their parents participated in this qualitative study. Participants were recruited through school nurses, primary care physicians, allergy specialists, and a patient support group and via a press release. Forty-five adolescents were identified as potential participants, 29 met inclusion criteria, and 3 declined to participate. Inclusion criteria included anaphylaxis within the past 5 years, an earlier reaction, and/or testing indicating high risk.
This qualitative study involved in-depth, semistructured interviews that explored adolescents’ accounts of anaphylactic reactions and issues related to epinephrine use. Interview topics included accounts of reactions, emergency management, and what might improve management. Eight adolescents and 10 parents participated in subsequent focus groups.
The majority of adolescents had neither self-administered nor been given epinephrine, despite reactions that warranted this medication. Eighteen adolescents reported anaphylactic reactions during which epinephrine was available; 11 of those reported not using their autoinjector. Barriers to epinephrine use included failure to recognize anaphylaxis, uncertainty about technique and when to administer epinephrine, and fear. Most adolescents reported carrying autoinjectors some of the time. Several participants found it inconvenient to carry autoinjectors. One reported not using an autoinjector because it was not carried.
Adolescents and parents reported underuse of epinephrine autoinjectors. Barriers to epinephrine use are complex and include inadequate training, motivation and self-discipline to carry the medication, ability to identify a reaction, knowledge of when to use the device, and preparation for managing the challenging emotions that accompany emergencies.
Previous studies have identified suboptimal use of epinephrine autoinjectors in the adolescent population. Delayed recognition and treatment of anaphylaxis can be fatal. This study explores multiple barriers to epinephrine use and explores potential interventions. Suggested interventions include education regarding recognition of anaphylaxis, aggressive use of autoinjectors, and training on proper autoinjector technique. Other future strategies may include improved autoinjector design and alternative epinephrine administration routes. The current study underscores the importance of education and training regarding anaphylaxis management for providers, patients, and families.
- Copyright © 2012 by the American Academy of Pediatrics