Underutilization of EpiPen® in food-allergic children experiencing anaphylaxis may be attributed to parental discomfort with administration, as measured by lack of parental self-perceived competence and knowledge of proper administration.

A written survey was mailed to parents of 360 children (<18 years) with physician-diagnosed food allergies who had been prescribed EpiPen®. Parents were recruited from local food allergy support groups and private allergy practices. A “COMFORT” score was measured using a 10-cm visual analog scale. “KNOWLEDGE” of proper EpiPen® use and anaphylaxis was tested. Self-perceived “COMPETENCE” was assessed using 16 psychological questions, including 11 from the Family Empowerment Scale. Multiple-regression analysis was used to determine how much of the variance in COMFORT ratings could be explained by KNOWLEDGE, perceived COMPETENCE, and other factors assessed in the survey.

We received 165 completed surveys (46%) with signed consent forms. Anaphylaxis was reported in 42.4% of children (n=70); 8.5% of parents (n=14) had administered EpiPen® to their child. Factors correlating with COMFORT included prior administration of EpiPen® (p=0.009), prior training of EpiPen® use (p=0.006), and COMPETENCE (p<0.0005). Neither a history of anaphylaxis nor KNOWLEDGE correlated with an increased level of COMFORT with administration.

COMPETENCE directly correlated with increased COMFORT with EpiPen® use, but KNOWLEDGE did not. Physicians should continue to instruct all parents on EpiPen® administration, specifically with a trainer, since this correlated significantly with COMFORT. Other psychological factors, beyond those examined here, may contribute to underutilization of EpiPen®. Future studies should explore these factors.