Inconsistences in Prescribing Epinephrine Autoinjectors

A key strategy in supporting patients at risk of anaphylaxis is the provision of self-administered epinephrine ("self-epi"). However, there seems to be a lower threshold for prescribing self-epi in food allergy than in venom allergy. Self-epi is often recommended to someone with the relatively low risk of food anaphylaxis (under 5%), yet a similar level of risk in a venom-allergic patient is considered not to justify self-epi. We can only speculate as to the reasons for this: it may be harder to avoid food allergens (which can be hidden and undisclosed) compared with a bee or wasp, and the effort needed to avoid food allergens is greater. Evidence suggests that self-epi does not reduce rates of hospitalization or fatal anaphylaxis. Therefore, the rationale for self-epi should be based on supporting patients and empowering them to lead a more normal life. Surprisingly, studies suggest that self-epi has an adverse impact on quality of life, perhaps because it creates a perception that those with self-epi are more at risk of a life-threatening reaction. We must be cognizant of the fact that when the risk of anaphylaxis is relatively low, the prescription of self-epi can be associated with harms as well as potential benefits.