Supervised self-injection with empty syringes improved comfort in food-allergic adolescents administering epinephrine, study finds

Eighty-three percent of the teenagers in the first-of-its-kind, randomized controlled study and 88 percent of parents, described the intervention as beneficial. Seventy percent of the youths said the intervention helped improve their ability to self-inject. The intervention may translate into significant clinical benefits.

Nearly 6 million children have food allergies in the United States. While deaths from anaphylaxis, a severe allergic reaction that causes shortness of breath, vomiting, and lightheadedness are uncommon, they occur most often in adolescents and young adults, particularly in reaction to peanuts and tree nuts. Epinephrine injections work to counteract the symptoms of anaphylaxis by opening airways and narrowing blood vessels. People with food allergies are advised to carry epinephrine auto-injectors with them at all times.

The authors' previous studies found that adolescents are at risk for not carrying their self-injector, often because of anxiety about self-injection. Investigators used the frameworks of cognitive behavioral and exposure therapy and found that exposure to the stressor in a controlled setting alleviated patients' stress.

"Many adolescent patients with food allergies experience needle phobia or anxiety about self-administering epinephrine," said the study's lead author, Eyal Shemesh, MD, Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai. "Although it's a simple idea for teenagers to practice giving themselves an injection to make themselves feel comfortable, this could lead to them being confident enough to take a life-saving action using epinephrine down the road." The study's senior author is Scott Sicherer, MD, Professor of Pediatrics, Allergy and Immunology at the Icahn School of Medicine at Mount Sinai.

The study included 60 participants aged 13-17.5 years old who had previously been diagnosed with a food allergy, and who had been prescribed an auto-injector but had never used it. They were accompanied by a parent or guardian to their appointments, and participants completed self-report questionnaires about their or their child's comfort with self-injection. Afterwards half of the participants injected themselves once with an empty syringe, supervised by a doctor. The other half functioned as the control group and received education about self-injection. The intervention group and control group participants answered the same set of questions after the injection and education, respectively. One month after the clinic visit, participants were mailed an identical follow-up questionnaire.