Parental use of EpiPen for children with food allergies

Background: EpiPen is often underused in children with food allergy experiencing anaphylaxis. Objective: We explored whether underuse of EpiPen might be attributed to parental discomfort with administration, as measured by a lack of parental empowerment and knowledge of proper administration. Methods: A written survey was mailed to parents of children with food allergy. Those children with physician-diagnosed food allergy who had been prescribed EpiPen were included in the analysis. Parents were recruited from a local food-allergy support group and private allergy practice. Perceived comfort with administering EpiPen was measured by using a 10-cm visual analog scale. Knowledge of EpiPen use and anaphylaxis was tested by using a series of multiple-choice questions. Empowerment was measured with a 16-item instrument that included statements from the Family Empowerment Scale. Multiple regression analysis was used to determine how much of the variance in the comfort ratings could be explained by knowledge, empowerment, and other factors assessed in the survey. Results: Of 360 mailed surveys, 165 (46%) completed surveys met the inclusion criteria and were analyzed. Anaphylaxis was reported in 42% of children (n = 70); 8% of parents (n = 14) had administered EpiPen to their child. Factors correlating with comfort included prior administration of EpiPen (P = .009), EpiPen training (P = .005), and empowerment (P < .0005). Neither a history of anaphylaxis nor knowledge correlated with an increased level of comfort with administration. Conclusions: Empowerment directly correlated with increased comfort with EpiPen use, but knowledge did not. Physicians should continue to instruct all parents on EpiPen administration because this correlated significantly with comfort. Other psychological factors beyond empowerment might contribute to underuse of EpiPen.