Supervised epinephrine autoinjector administration in a cohort of children with anaphylaxis during oral food challenges (OFCs)
Monday, March 5, 2018
South Hall A2 (Convention Center)
Lianne Soller, PhD, Timothy Teoh, MD, Ingrid Baerg, RN, BSN, Tracy Gonzalez, RN, BSN, Tiffany Wong, MD, FRCPC, Kyla J Hildebrand, MD, FRCPC, MScCH (HPTE), Edmond S. Chan, MD, FRCPC

An epinephrine autoinjector (e.g. EpiPen®, Auvi-Q®) is the treatment of choice for anaphylaxis in the community. However, studies show it’s often not administered, due to factors including lack of confidence and fear. We previously reported improved confidence after medical supervision of parent/child autoinjector administration during OFCs. We sought to confirm those findings in a larger cohort of children.


Parents of children undergoing OFC at BC Children’s Hospital filled out a pre-challenge questionnaire on 1) confidence in recognizing anaphylaxis, 2) confidence with autoinjector administration, 3) knowledge of anaphylaxis/autoinjector use, and 4) skill in autoinjector use. Confidence was measured on a 5-point scale (1=Not very confident to 5=Very confident). Children experiencing anaphylaxis had parent/self autoinjector administration under medical supervision, and confidence was re-assessed post-challenge.


Among 308 OFCs performed in 287 children, 50 had anaphylaxis requiring an autoinjector (16.2%). Twenty-one were OFCs to peanut (42%). There was a significant increase in all four confidence domains from pre- to post- challenge (p=0.02 for domain 1; p<0.001 for domain 2; p=0.002 for domain 3; p<0.001 for domain 4). Those reporting an increase in confidence recognizing anaphylaxis/autoinjector administration were more likely to be healthcare professionals (p=0.037); those reporting an increase in confidence with autoinjector administration (p=0.042) and knowledge of anaphylaxis/autoinjector use (p=0.045) were more likely to have older allergic children.


Our anaphylaxis rate for OFCs was relatively high. Supervised parent/child autoinjector administration during OFCs increased confidence significantly across multiple domains, which could translate to higher likelihood of future autoinjector use for anaphylaxis in the community.