Parental Use of EpiPen for Children With Food Allergies
Authors: Davis Karla L. , Mikita Cecilia P. 
Published: September 2006

Purpose of the Study.
Food allergy affects up to 6% of children, and adverse reactions can be fatal. Appropriate emergency treatment consists of early administration of injectable epinephrine. Previous studies have revealed deficiencies in parental knowledge surrounding indications for self-injection, deficiencies in the method of EpiPen administration, and underuse in children experiencing anaphylaxis. This study explores whether underuse of EpiPen may be attributed to parental discomfort with administration, as measured by a lack of parental empowerment and knowledge of proper administration.

Study Population.
Parents of children with physician-diagnosed food allergy who had been prescribed an EpiPen.

Methods.
A self-administered survey was mailed to parents of children with food allergy, recruited through a food-allergy support group and a pediatric allergist’s practice. The questionnaire collected demographic information, medical history, history of previous “life-threatening allergic reaction(s),” past experience with EpiPen use, and knowledge of EpiPen indications. Knowledge was assessed with a series of multiple-choice and true/false queries. Perceived parental comfort with EpiPen administration was measured with a 10-cm analog scale, anchored with “uncomfortable” versus “very comfortable” at either end. Empowerment was measured with a 16-item instrument, including statements directly from or modified from the previously validated Family Empowerment Scale.

Results.
Of 360 mailed surveys, 165 eligible surveys were included in the study (46%). The majority of respondents were married white mothers with college or advanced degrees. The children of respondents ranged in age from 1 to 19 years. Previous anaphylaxis was reported in 70 responses (42%). Fourteen parents (8%) had administered the EpiPen to their child. Factors correlating with parental comfort with EpiPen administration included previous administration of EpiPen, EpiPen training, and high empowerment scores. Neither a history of previous anaphylaxis nor parental knowledge correlated with an increased level of reported comfort with EpiPen administration.

Conclusions.
Increased empowerment scores directly correlated with increased parental comfort with EpiPen use. Although increased knowledge scores did not prove to be a significant contributor to parental comfort, training on EpiPen use is an important component in improving parental comfort. The authors question the impact of other psychological factors, such as fear, that may contribute to underuse of the EpiPen.

Reviewer Comments.
Previous studies of parental EpiPen administration have reported incorrect use of autoinjectors despite training at the time of prescription. This study suggests that factors beyond parental knowledge are critical for proper administration of this potentially life-saving medication. The importance of hands-on training to increase caregiver comfort is underscored by this study. Demonstration units and training videos are available free of charge through the manufacturers for EpiPen and the Twinject, another epinephrine self-injection unit not discussed in this study.