Background and Significance
Anaphylaxis is a rapid-onset, potentially life-threatening systemic
allergic reaction. 1,2 Immediate administration of
intramuscular epinephrine can prevent mortality, hospitalization and
biphasic reactions.345 For these reasons, national and
international guidelines recommend prescribing an epinephrine
autoinjector (EAI) to any patient at increased risk for
anaphylaxis,6,7 and specify that all patients who have
experienced an anaphylactic reaction should beprovided an action plan
instructing them on how and when to administer
epinephrine.8Despite these recommendations, for a
multitude of reasons, EAIs are underused in the treatment of
anaphylaxis.9
Socioeconomic statuslikely influences accessibility to EAIs. Since 2007
the average wholesale price of EpiPenī, the most commonly prescribed
EAI, increased by 545% to around $730 for a 2 pack in
2016.10 Children from higher income households are
more likely to be prescribed an EAI,11 and children
with private insurance are more likely to receive early epinephrine
administration for anaphylaxis.12 In addition to
socioeconomic disparities, racial and ethnic disparities in anaphylaxis
treatment also exist. Non-white children are less likely to receive
early epinephrine administration.5
It is unclear if these disparitiesare attributable to prescribing
practices, lack of prescription filling, lack of EAI availability when
needed or lack of use when needed, despite availability. The primary aim
of this study was to measurerates of EAI prescription filling and to
determine if there are differences in the rate of filling of EAI
prescriptions among patients of different socioeconomic
characteristicsdischarged from the pediatric emergency department (ED)
after a visit for anaphylaxis.