Common mistakes when using epinephrine autoinjectors

Epinephrine is commonly prescribed for the treatment of anaphylaxis.  For families of children with potentially serious allergies, using epinephrine autoinjectors, such as Epipen or Auvi-Q, in an emergency is not only safe and appropriate, but absolutely necessary. Delay in giving epinephrine during anaphylaxis has been linked to deadly outcomes for children with serious allergies.

Despite the importance of this medication, recent studies have demonstrated that a high percentage of patients prescribed epinephrine autoinjectors are unprepared to use the device correctly. Researchers at the University of Texas recently found that only 16 percent of patients were able to demonstrate all the steps needed to properly inject the medication.

Common mistakes included holding the device in place for less than ten seconds after injection, placing the wrong end of the injector onto the thigh, and pushing too lightly for the device to release the medicine, according to the study from the Annals of Allergy, Asthma, and Immunology in December 2014.

When a child has a serious allergy, learning about this diagnosis can be overwhelming and scary, especially at first. There is a lot of information to process at the initial visit.  For this reason, we spend a great deal of time educating parents and patients during allergy visits on the proper technique for using an epinephrine autoinjector.  We want to make sure patients and families understand all of our recommendations when an epinephrine device is prescribed, and that these directions are reviewed frequently. In addition, your child's written allergy action plan should detail proper use of an epinephrine autoinjector.

There is another reason for reviewing epinephrine autoinjector use at every visit: even people who demonstrate correct technique at an office visit can forget steps during the stress of an emergency. For example, we have seen some parents accidentally grip the device incorrectly and inject the medication into their thumb. This is not only painful, but also administers the medication to the wrong person.

With teenage patients, adherence problems may increase. Many teens either accidentally or purposely do not carry their epinephrine devices. Unfortunately, it is not good enough to have the medication nearby; it needs to be carried at all times.  A new product, Auvi-Q, is a compact epinephrine autoinjector that some patients find easy to carry. It's the size of a small cell phone and its dimensions make it easier to put in a pocket. It also talks the patient through the steps of giving the medicine.

Regardless of the device that is carried, we recommend always carrying two doses of epinephrine.  This is needed because although epinephrine works quickly, a second dose could be required before help arrives.  Carrying two doses also provides protection in case of a mistake while using an epinephrine autoinjector.

If anaphylaxis is suspected, you should always call 911.  If an epinephrine autoinjector is available, it should be given and then 911 called. If epinephrine is not available, the call to 911 should happen immediately. For children at risk, having epinephrine readily available is critical. We should continue educating our patients and families and also look for creative ways – such as automatic prompts to remind patients to take their epinephrine devices with them when leaving home – to increase adherence.

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