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Deprescribing Self-Administered Epinephrine: Why, Who, and When?
Karla E Adams1, Nandinee Patel2, Vishaka R Hatcher1
1Wilford Hall Ambulatory Surgical Center, Lackland AFB, San Antonio, Texas.
The Journal of Allergy and Clinical Immunology. in Practice
|December 22, 2025
Summary
Self-administered epinephrine (self-epi) for anaphylaxis requires careful consideration. Deprescribing self-epi should be individualized, balancing risks and patient preferences through shared decision-making.
Area of Science:
- Allergy and Immunology
- Clinical Pharmacology
Background:
- Epinephrine is the primary treatment for anaphylaxis.
- Self-administered epinephrine (self-epi) is common for high-risk patients.
- Ongoing self-epi use has financial costs and can negatively impact quality of life.
Purpose of the Study:
- To review clinical scenarios for deprescribing self-epi.
- To discuss factors influencing decisions about continuing or stopping self-epi.
- To emphasize shared decision-making in managing self-epi.
Main Methods:
- Literature review of studies on anaphylaxis treatment and self-epi.
- Analysis of factors influencing self-epi prescription and deprescribing.
- Discussion of clinical, psychosocial, economic, and medicolegal considerations.
Main Results:
- Self-epi deprescribing is complex and requires individualized assessment.
- Risk of anaphylaxis can change over time due to various factors.
- Venom and food immunotherapy may influence the need for self-epi.
Conclusions:
- Deprescribing self-epi should be a dynamic, individualized process.
- Shared decision-making between patient and prescriber is crucial.
- Management of self-epi needs to adapt to evolving patient risk and treatment milestones.
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