Patients need more education about epinephrine auto-injectors, study finds

Pharmacists can have patients practice proper EAI use in the pharmacy

Deven Jackson, PharmD, from Sona Pharmacy + Clinic in Asheville, NC, has noticed that fewer patients are having trouble obtaining epinephrine auto-injectors (EAIs) because of cost issues—a stark contrast to what he was seeing at this time last year. While that’s positive news, it doesn’t mean that patients are necessarily using or carrying their EAIs. Studies have suggested that many at-risk individuals often don’t have EAIs on hand during an allergic episode. 

A published in the Annals of Allergies, Asthma, and Immunology found that while most patients filled a recent epinephrine prescription, a large number did not routinely carry their prescribed EAIs, despite having experienced severe reactions in the past. As pharmacists know, epinephrine is the medication of choice for first-aid treatment of anaphylaxis. 

“Nearly half of participants said they didn’t have their prescribed EAI with them during their most severe allergic reaction, even though 78% of respondents had been hospitalized for their allergy at some point in their lifetime,” said lead author Ruchi Gupta, MD, MPH, from Northwestern University Feinberg School of Medicine in Chicago.

Her research team performed a cross-sectional survey of eligible English-speaking U.S. adults who had been prescribed an EAI or had a child who had been prescribed one for an allergy that included certain foods, latex, insect bites, medications, and more. The final sample consisted of survey responses from more than 900 adults and children (adults provided both self- and parent-proxy responses).

“Our goal was not only to characterize current epinephrine carriage and use practices in the U.S., but also to identify the barriers that prevent patients from filling their prescriptions [for], carrying, and using their epinephrine as recommended,” said Gupta.

Researchers solicited recommendations from study participants about changes they’d like to see so that EAIs are easier to access and use in an emergency.

Gupta said one of the main takeaways from the study was the expressed need for increased education.

“In our study, many patients who filled their EAI prescription reported that they were not confident in their ability to properly use it,” she said. Participants also expressed doubts in their ability to recognize the signs and symptoms of a severe allergic reaction.

“This provides a really amazing opportunity for pharmacists,” said Gupta. “In addition to providing patients with information about symptom identification and management, pharmacists can have their patients practice proper EAI use in the pharmacy.”

Most patients are prescribed EpiPens, which contain a trainer in the two-pack box.

“Even if they say they know how to use it, I usually take the trainer out and demo it on my leg real quick so they are familiar with it,” said Laura Knockel, PharmD, BCACP, ambulatory care clinical pharmacist at the University of Iowa Hospitals & Clinics. “I judge their reaction and see if I need to go into more detail.”

Though the cost issue has improved since last year, it continues to be a barrier to patients obtaining EAIs, the study researchers pointed out.

According to the survey, 89% of respondents reported filling an EAI prescription. For adults, the common cited barriers for filling their prescription were cost (47%) followed by the perception that their allergy was not severe (23%). For children, the most common barrier was no history of previous reactions (28%) and the perception that an EAI wasn’t needed (25%).

In addition to educating patients, Knockel said, pharmacists have another important role: helping patients afford EAIs, whether by identifying copay cards or accessing formularies to find out if a generic option is preferred.

For the full article, please visit for the September 2018 issue of Pharmacy Today.