Prescribing epinephrine injection (EPIPEN) for anaphylaxis in primary care – a survey

Background Epinephrine injection (Epipen) is the definitive treatment for anaphylaxis. Life threatening airway, breathing or circulation manifestations or minor reactions that is skin or other systemic changes with a background of asthma or multiple allergies (minor reaction plus) indicate the need for Epipen according to Resuscitation Council UK guidelines (2008). Patient education is provided by the paediatric allergy nurse (PAN) specialist. Aim To determine the practice of prescribing Epipen in Primary Care in a district. Methods A simple questionnaire was sent to all the 64 General Practitioner (GP) Surgeries in our district through an online link. GPs have a desk-top referral guide on management of paediatric anaphylaxis. Every GP practice has software (SystmOne) on the computer system leading to easier identification of children prescribed Epipen. Weekly electronic reminders were sent for 4 weeks. Results Responses on 88 children on Epipen were received and summarised in table 1. Abstract G99(P) Table 1 Age of child at first presentation Mean (range) Months ≤5 years n(%) 6-11 yearsn(%) ≥12 years n(%) 64.7 (6-169) 42(48) 42(48) 4(4) Indication Life threatening symptoms n(%) Minor reaction Plus n(%) Simple minor reaction n(%) 21(24) 19(21.5) 48(54.5) Initiator of prescription GP n(%) Hospital Paediatrician n(%) PANn(%) 38(43) 41(47) 9(10) Follow up with PAN (Education Plan) Yesn(%) Non(%) Don't Known(%) 70(80) 10(11) 8(9) Offending allergen identified Yes n(%) No n(%) 77 (87.5) 11(12.5) Epipen used Yes n(%) No n(%) 3(3.4) 85(96.6) Number of children on repeat prescriptions Yes n(%) No n(%) 79(90) 9(10) Number of Epipen prescribed by GP 1n(%) 2n(%) >2n(%) Don't known(%) 19(21.6) 18(20.4) 6(7) 45(53) Conclusions Significant numbers of Epipen are being inappropriately prescribed (55%). 43% of Epipen prescriptions were initiated by the GP without further specialist help and of these, 11% children did not have an education plan for future anaphylaxis management. There appears to be a wide variation in the numbers of Epipen prescribed on first visit. Further training and dissemination of anaphylaxis guideline in Primary care is planned soon.