The Dec. 12, 2016 webinar –When Should I Use Epi? Why Am I Afraid of It? –featured Jonathan Spergel, MD PhD. Dr. Spergel is Professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine. At Children’s Hospital of Philadelphia, he is Chief of the Allergy Section and Director of Center for Pediatric Eosinophilic Disorders. Dr. Spergel began his talk with a brief discussion of anaphylaxis, noting that fatal anaphylaxis from food allergy is very rare and listing several factors that are often associated with these rare food allergy deaths, including underlying asthma, allergies to certain foods (peanut, tree nut and milk), and adolescence or young adulthood. Importantly, he indicated that reaction severity cannot be predicted on the basis of blood tests that measure food-specific IgE or skin tests that measure wheal size.
Next, Dr. Spergel considered the risks of delaying the administration of epinephrine. When epinephrine is given late in a reaction, patients are more likely to:
- require hospitalization
- experience a biphasic reaction, in which anaphylaxis symptoms disappear for a time and then return
- suffer a rare fatal reaction
The doctor’s take-home message – “With anaphylaxis, you need to use epinephrine” – was highlighted by a brief explanation of how epinephrine works and a remarkable animation showing the physiological events and observable symptoms of anaphylaxis.
In the next part of the talk, Dr. Spergel discussed barriers that discourage or prevent patients and caregivers from using epinephrine. In some instances, patients might not have epinephrine prescribed to them or available with them. In other cases, the patients or their families hope to avoid a visit to the emergency room. Many additional barriers result from fears, such as:
- Causing injury with the auto-injector’s needle
- Using the epinephrine incorrectly
- Triggering an adverse event
Dr. Spergel noted that the risks associated with using epinephrine are minimal. Patients don’t report pain or injury from the auto-injector, and any severe side effects reported from epinephrine use are associated with intravenous administration rather than intramuscular injection using an auto-injector.
According to Dr. Spergel, emergency departments have greatly improved how they treat anaphylaxis, with 97 percent of anaphylaxis patients now receiving epinephrine, versus less than two-thirds of patients in the past. However, emergency medical technicians give epinephrine much less frequently, in about one-third or less of anaphylaxis cases.
The presentation ended with an informative and wide-ranging Q and A session, in which Dr. Spergel answered questions from registered webinar participants.