Correspondence
`
`EMPOWERING PATIENTS WITH A HISTORY OF
`ANAPHYLAXIS TO USE AN EPINEPHRINE
`AUTOINJECTOR WITHOUT FEAR
`
`To the Editor:
`As we are all aware, the prevalence of food allergies has
`increased across all age groups. Although several theories
`regarding cause exist, no definitive consensus has been
`reached. To date, the only treatment offered to patients is the
`combination of strict avoidance of the causal food and a
`comprehensive understanding of how to treat anaphylaxis
`with epinephrine. For health care professionals who have not
`treated anaphylaxis, anxiety associated with it is truly uncom-
`fortable even when death is not imminent. As a result, the use
`of epinephrine in the treatment of anaphylaxis, regardless of
`etiology, becomes all the more important.
`Numerous studies1– 4 in the literature address the infrequent
`use of epinephrine autoinjectors (EpiPen; Dey LP, Napa,
`Calif) by patients and parents of allergic children and the lack
`of understanding of how to use EpiPens by physicians and
`patients. A recent article5 discussed potential psychological
`factors that might affect use of an EpiPen by parents of
`allergic children. In addition to the many factors postulated
`for the delayed use or nonuse of the EpiPen, I have found that
`in adolescents and young adults, fear of the EpiPen itself,
`specifically, how the needle feels and how the epinephrine
`makes you feel, contributes to the failure of the proper and
`timely use of the EpiPen. Because adolescents and young
`adults spend less time at home or under adult supervision, the
`ability to self-administer an EpiPen becomes crucial.
`Approximately 2 years ago, a patient of mine had a near-
`fatal anaphylactic reaction to a peanut. This 21-year-old
`woman tried to convince herself that she was not having the
`reaction she was most certainly having. Rather than use her
`EpiPen, she decided to walk to the hospital, which was only
`a block away. After her discharge from the hospital I asked
`why she did not use her EpiPen, and she told me that she was
`scared to use it because she did not know what it felt like.
`After this scenario, I realized that she was most likely not
`
`alone in her feelings and that other children and young adults
`probably have the very same feelings and concerns. In an
`effort to prevent another near fatality because of patient
`failure to use the EpiPen, I decided that I was going to have
`adolescents and young adults administer their own EpiPen
`while in my office so that they would know exactly how to
`use it and what it feels like and become more comfortable
`with it. After having approximately 60 patients do this exer-
`cise in my office, the response by these patients and their
`parents has been universally extremely positive.
`Parents have consistently commented that this exercise has
`relieved a lot of parental anxiety. All patients who have
`undergone this exercise have expressed relief after adminis-
`tering the EpiPen and now feel confident that they are more
`empowered to use their own EpiPen if needed and without
`hesitation.
`
`JAMES P. ROSEN, MD, FAAAAI
`Department of Pediatrics
`University of Connecticut School of Medicine
`Farmington, Connecticut
`No funding from any biotechnology or pharmaceutical com-
`pany was received for the preparation of this letter. Dr Rosen
`is on the speaker’s bureau for Dey LP.
`
`REFERENCES
`1. Gold MS, Sainsbury R. First aid anaphylaxis management in
`children who were prescribed an epinephrine autoinjector de-
`vice (EpiPen). J Allergy Clin Immunol. 2000;106:171–176.
`2. Huang SW. A survey of EpiPen use in patients with a history of
`anaphylaxis. J Allergy Clin Immunol. 1998;102:525–526.
`3. Sicherer SH, Forman JA, Noone SA. Use assessment of self-
`administered epinephrine among food-allergic children and pe-
`diatricians. Pediatrics. 2000;105:359 –362.
`4. Simons FER. First-aid treatment of anaphylaxis to food: focus
`on epinephrine. J Allergy Clin Immunol. 2004;113:837– 844.
`5. Kim JS, Sinacore JM, Pongracic JA. Parental use of EpiPen for
`children with food allergies. J Allergy Clin Immunol. 2005;116:
`164 –168.
`
`418
`
`ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY
`
`Opiant Exhibit 2185
`Nalox-1 Pharmaceuticals, LLC v. Opiant Pharmaceuticals, Inc.
`IPR2019-00685
`Page 1
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