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›š, 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.