Los Angeles—The public outcry when the price of epinephrine autoinjectors dramatically increased a few years ago seemed to demonstrate how dependent patients are on the products.

In light of that, a new study came up with a surprising finding: More than half of the time, epinephrine autoinjectors (EAIs) aren’t used when necessary in emergency situations.

Epinephrine is considered the most effective treatment for anaphylaxis, which might explain the strong reaction when the price of a two-pack of the branded Epi-Pen product shot up more than 500% from 2007 to 2016, from about $100 to more than $600.

A new study published in the Annals of Allergy, Asthma and Immunology found, however, that when an emergency actually arose, 52% of adults with potentially life-threatening allergies didn’t use the EAI prescribed for them.

Those results were based on 597 surveys representing 917 respondents prescribed an EAI, since some parents answered the survey for both their child and themselves, according to a study team led by researchers from the University of Southern California Keck School of Medicine.

“The majority of people surveyed (89 percent) filled the prescriptions they were given for an EAI,” pointed out lead author Christopher Warren, PhD(c). “But almost half (45 percent) said they didn’t have their EAI with them during their most severe allergic reaction. This was despite the fact that 78 percent of the people responding had been hospitalized for their allergy at some point in their lifetime. Another 21 percent said they didn’t know how to use their EAI.”

The American College of Allergy, Asthma and Immunology recommends that patients prescribed EAIs should have the injector with them at all times and, in fact, should carry two in case of a severe reaction.

Those guidelines further state that epinephrine should be administered at the first sign of an anaphylactic reaction, especially for those who have had a previous anaphylactic reaction or who have both a severe allergy and asthma.

“It’s not enough to simply pick up your EAI prescription,” explained coauthor Ruchi Gupta, MD, MPH, of Northwestern University Feinberg School of Medicine. “You need to know how to use your EAI and always carry it, to be prepared for an allergy emergency. It could save your life.” 

Survey results revealed that about half of the survey participants reported that an EAI was accessible to them within 5 minutes all the time, and 44% said that they personally carried at least one EAI all the time. Yet, fewer than a fourth of those surveyed said they regularly carried more than one EAI to protect against severe allergic reactions.

“Studies suggest that such allergies are remarkably common in the United States, with food allergies (FA) in particular having substantially risen in prevalence over recent decades to affect an estimated 8% of children and 5% of adults,” the study authors noted. 

“Clinically, there is substantial variation in how allergic reactions can present and reactions to the same food can vary in severity.”

While the recent study decries the lack of use and understanding of the products, some EAIs still are plagued by drug shortages. The FDA recently called the medication supply “a continuously evolving and fast-moving issue.”

The FDA blamed the limited availability of EpiPens on a range of factors, including regional supply disruptions and manufacturer issues, in certain areas of the U.S. Douglas Throckmorton, MD, deputy center director for regulatory programs in FDA’s Center for Drug Evaluation and Research, said that the scarcity is expected to be short-term and pointed out that information on other approved epinephrine autoinjector products is on the FDA website.
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