Current Allergy and Asthma Reports

, Volume 11, Issue 1, pp 65–70

Epinephrine Autoinjector Refill History in an HMO

  • Michael S. Kaplan
  • Sandy Y. Jung
  • Matthew L. Chiang
Article

DOI: 10.1007/s11882-010-0155-6

Cite this article as:
Kaplan, M.S., Jung, S.Y. & Chiang, M.L. Curr Allergy Asthma Rep (2011) 11: 65. doi:10.1007/s11882-010-0155-6

Abstract

Epinephrine can be lifesaving in episodes of anaphylaxis, yet it is underprescribed and underused. Tracking of epinephrine refills over time for patients with a diagnosis of anaphylaxis has not been reported. This study reports on the refill history of 14,677 patients in a large HMO who received an initial dispensing of EpiPen (Dey Pharma, Basking Ridge, NJ) or EpiPen Jr between 2000 and 2006. A total of 6,776 (46%) refilled at least once. Twenty-five percent of the patients who were in the cohort for 5 years or more refilled multiple times, and 11% refilled consistently at all expected refill times. Infants through children 12 years of age were more likely to receive a refill dispensing (63%) compared with teenagers and adults (40%). The most common ICD-9 codes that were linked to the initial epinephrine dispensing were allergic disorder (37%), miscellaneous anaphylaxis/angioedema (23%), hymenoptera/insect bite or sting (14%), and specific or nonspecific food allergy (11%). A total of 79% of patients with a food-related ICD-9 code and 59% of patients with an insect sting-related ICD-9 code refilled epinephrine at least once. An opportunity exists to identify system-based as well as personal barriers in an ongoing effort to provide patients at risk with the tools and empowerment that could reduce their risk during life-threatening anaphylactic reactions.

Keywords

Anaphylaxis Severe allergic reaction Epinephrine autoinjector 

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Michael S. Kaplan
    • 1
  • Sandy Y. Jung
    • 1
  • Matthew L. Chiang
    • 1
  1. 1.Department of Allergy and Clinical Immunology, Kaiser PermanenteLos Angeles Medical CenterLos AngelesUSA