Food allergy, dermatologic diseases, and anaphylaxis
Parental use of EpiPen for children with food allergies

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Background

EpiPen is often underused in children with food allergy experiencing anaphylaxis.

Objective

We explored whether underuse of EpiPen might be attributed to parental discomfort with administration, as measured by a lack of parental empowerment and knowledge of proper administration.

Methods

A written survey was mailed to parents of children with food allergy. Those children with physician-diagnosed food allergy who had been prescribed EpiPen were included in the analysis. Parents were recruited from a local food-allergy support group and private allergy practice. Perceived comfort with administering EpiPen was measured by using a 10-cm visual analog scale. Knowledge of EpiPen use and anaphylaxis was tested by using a series of multiple-choice questions. Empowerment was measured with a 16-item instrument that included statements from the Family Empowerment Scale. Multiple regression analysis was used to determine how much of the variance in the comfort ratings could be explained by knowledge, empowerment, and other factors assessed in the survey.

Results

Of 360 mailed surveys, 165 (46%) completed surveys met the inclusion criteria and were analyzed. Anaphylaxis was reported in 42% of children (n = 70); 8% of parents (n = 14) had administered EpiPen to their child. Factors correlating with comfort included prior administration of EpiPen (P = .009), EpiPen training (P = .005), and empowerment (P < .0005). Neither a history of anaphylaxis nor knowledge correlated with an increased level of comfort with administration.

Conclusions

Empowerment directly correlated with increased comfort with EpiPen use, but knowledge did not. Physicians should continue to instruct all parents on EpiPen administration because this correlated significantly with comfort. Other psychological factors beyond empowerment might contribute to underuse of EpiPen.

Section snippets

Study participants

Parents of children with food allergy were recruited through mailings to members of a local suburban food-allergy support group and to patients of a private pediatric allergist's practice. Inclusion criteria required physician-diagnosed food allergy, and all patients must have been prescribed EpiPen for home use. Participants were limited to parents, and children were not surveyed. Survey data were limited to one child per parent; if surveys had been completed for multiple children from the

Results

Surveys were returned by 170 families. Three surveys were returned without signed consent forms, and 2 subjects had food allergy but had not been prescribed EpiPen. These surveys were not included in the data analysis. Hence 165 completed surveys with signed consent were included in the study, for a response rate of 46% (165/360).

The vast majority of respondents were married white mothers who held college or graduate degrees (Table II). The only minority represented were Asians, who made up 5%

Discussion

Self-injectable epinephrine, currently available in the form of EpiPen and EpiPen Jr in the United States, is a critical element of the treatment plan for IgE-mediated food allergies. There are an estimated 150 deaths per year in the United States attributed to anaphylaxis caused by food allergy.3 The median time to respiratory or cardiac arrest was found by one study12 to be 30 minutes for food anaphylaxis. Bock et al3 reported on 32 fatalities, but it could be confirmed that epinephrine was

References (15)

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  • Parent perceptions in managing children with food allergy: An Australian perspective

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    A key finding of this study was the importance of social acceptance as parents internalised risk when navigating challenges in keeping their child safe. The importance of health literacy,5,40 empowerment29,37 and external support from community members,41 and food manufacturers,21 builds confidence and overcomes parental fear as parents tackle the reported challenges when managing a child with food allergy. All authors have provided their consent for publication of this manuscript.

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Supported by the Division of Allergy, Children's Memorial Hospital.

Disclosure of potential conflict of interest: All authors—none disclosed.

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