To the Editor: The Australian Pharmaceutical Benefits Scheme records 35 657 prescriptions (for either one or two devices) for EpiPen autoinjectors (CSL Limited, Melbourne, VIC), the self-injectable form of adrenaline, in 2006. This is a 650% increase on the 4758 prescriptions for EpiPens in 1998. The increase is much greater than the increase in the rate of food allergy.

It is not enough to merely prescribe an EpiPen. It is vital that carers (of children), patients and prescribers understand its use. A previous South Australian study of children who had been prescribed an EpiPen at an allergy clinic found that, in 71% of severe reactions, the parents failed to use the device appropriately. Another study found that only two of 100 doctors in a major Australian paediatric teaching hospital could correctly demonstrate EpiPen use.

In 2006, we surveyed EpiPen use by 120 parents of children attending the allergy clinic at the Children’s Hospital at Westmead. Children with egg allergy who were aged under 5 years when seen in 2003 were selected. Seventy per cent (84/120) of the children were prescribed an EpiPen. Half of the children had additional food allergies. Of those prescribed an EpiPen, 69% always carried it, 13% often carried it, 13% sometimes carried it and 5% never carried it. Ten per cent of parents had ever used the device, and 86% stated they were confident that they knew how and when to use it. Despite this, almost 40% stated they had concerns about using the EpiPen in an emergency. These included doubting their ability to correctly administer the EpiPen, whether they would have enough time and would inject correctly, concerns they may hurt their child, concern for the child in the event they needed it, doubt about the effectiveness of the EpiPen, and concern about appropriate timing.

In the United Kingdom, 69% of parents were found to have problems using the EpiPen.4 Where, when and how to use the EpiPen was recently identified as one of 12 core parental information needs in our clinic.5 The findings that, even for parents of children attending a specialist allergy clinic where education strategies for EpiPen use are in place, 30% did not always carry the EpiPen, and 40% had concerns about its use in an emergency situation highlight the facts that just providing the device is an inadequate measure and that education and reinforcement, both in EpiPen use and in avoiding relevant allergens, are critical.