Timing the transfer of responsibilities for anaphylaxis recognition and use of an epinephrine auto-injector from adults to children and teenagers: pediatric allergists' perspective

Ann Allergy Asthma Immunol. 2012 May;108(5):321-5. doi: 10.1016/j.anai.2012.03.004.

Abstract

Background: The optimal time for transferring responsibilities for anaphylaxis recognition and epinephrine auto-injector use from adults to children and teenagers has not yet been defined.

Objective: To determine whether pediatric allergists have age-specific goals for beginning to transfer responsibilities for anaphylaxis recognition and epinephrine auto-injector use from parents and caregivers to children and teenagers at risk of anaphylaxis in the community.

Methods: Members of the American Academy of Pediatrics Section on Allergy and Immunology (AAP-SOAI) were surveyed about when they typically begin to transfer these responsibilities from adults to children and teenagers.

Results: Eighty-eight allergists responded to the survey, 97.7% of whom provided service to children and teenagers with food allergies. Few allergists expected to begin transferring responsibilities for anaphylaxis recognition and epinephrine auto-injector use to children younger than 9 to 11 years. By the time their patients reached age 12 to 14 years, however, most allergists expected them to be able to describe some anaphylaxis symptoms (95.4%), demonstrate how to use an epinephrine auto-injector trainer (93.1%), begin carrying self-injectable epinephrine (88.2%), recognize the need for epinephrine (88.1%), learn to self-inject epinephrine (84.5%), and be able to self-inject epinephrine (78.6%) (cumulative data). The allergists rated the following as "very important" readiness factors for beginning to transfer responsibilities: medical history, developmental level, and ability to demonstrate auto-injector technique.

Conclusion: Most pediatric allergists expected that by age 12 to 14 years, their patients should begin to share responsibilities with adults for anaphylaxis recognition and epinephrine auto-injector use; however, they individualized the timing based on assessment of patient readiness factors.

MeSH terms

  • Adolescent
  • Adrenergic Agonists / administration & dosage*
  • Adrenergic Agonists / therapeutic use
  • Allergy and Immunology*
  • Anaphylaxis / diagnosis
  • Anaphylaxis / drug therapy
  • Anaphylaxis / physiopathology
  • Anaphylaxis / prevention & control*
  • Child
  • Epinephrine / administration & dosage*
  • Epinephrine / therapeutic use
  • Food Hypersensitivity / drug therapy
  • Health Care Surveys
  • Humans
  • Injections, Intramuscular
  • Pediatrics*
  • Physicians / psychology*
  • Self Care*
  • Time Factors
  • Transfer, Psychology
  • Young Adult

Substances

  • Adrenergic Agonists
  • Epinephrine