Effects of treatment guidelines for the management of anaphylaxis on patient and caregiver adherence

OBJECTIVE Treatment guidelines recommend a prescription for two doses of an epinephrine auto-injector (EAI) be given at discharge following an anaphylactic event and patients carry these at all times to ensure timely access to epinephrine. However, previous research suggests approximately 30% of patients will not carry any EAI, and of those that do, approximately 10% have expired. This web-based US survey aims to understand patients’ and caregivers’ adherence to these proposed treatment guidelines. METHODS 159 patients aged 18–65 years ( M = 29.7; 32.1% male) and 215 caregivers of individuals under aged 18 years ( M = 23.3; 39.5% male) participated in the survey. All participants had been prescribed an EAI for self-administration or for administration as a caregiver. The survey took place between November 15 and November 30, 2015. RESULTS 18.2% of patients and 15.4% of caregivers did not store a single EAI at home; 61.0% of patients and 62.8% of caregivers indicated only one EAI was available at home. 83.0% of patients did not have access to an EAI at work and 35.8% of caregivers reported their child did not have access to an EAI at school. Only 8.0% of caregivers indicated two EAIs were available for their children at school. Caregivers were more likely to identify lack of training as the cause of an error compared to patients (p=0.02). No difference was identified for EAI compliance between those treating anaphylaxis with an EAI and those who have not used an EAI. CONCLUSION This survey revealed a suboptimal adherence to proposed treatment guidelines on the part of patients and caregivers. The findings bring into question the reliability of current education systems and safety information delivered by healthcare providers and retained by EAI users.