Clinical Technology
Adult Immunization
Hepatology
Pediatric Immunization
Screening
Psychiatry
Allergy
Women's Health
Cardiology
Pediatrics
Dermatology
Endocrinology
Pain Management
Gastroenterology
Geriatrics
Infectious Disease
Obesity Medicine
Rheumatology
Oncology
Nephrology
Neurology
Pulmonology

Adult Immunization Allergy & Immunology Cardiology Dermatology Endocrinology Gastroenterology Infectious Disease Men’s Health Nephrology Neurology Pain Management Pediatric Immunization Pediatrics Psychiatry Pulmonology Rheumatology Screening Women’s Health

Billing and Collections Career Planning Coding and Documentation Concierge Medicine Cybersecurity EHRs Investing Patient Relations Personal Finance Practice Management Remote Patient Monitoring Staffing Technology Telehealth Value-based Care

VMS and Menopause Scratching the Surface: A Deeper Dive Into Atopic Dermatitis Adult Immunization Provider Toolkit Dermatology Hot Topics

Act Fast: Ensuring Rapid Anaphylaxis Treatment with Intranasal Epinephrine : Episode 4

An Opportunity for Innovation: Rethinking Unmet Needs in Epinephrine Administration

June 10, 2025

Sakina S. Bajowala, MD

Opinion

Video

A panelist discusses how multiple barriers prevent timely epinephrine use, including patient reluctance to use auto-injectors, lack of device availability, uncertainty about administration timing, and cost concerns, leading to widespread underuse.

EP: 1.Understanding Anaphylaxis: The Signs, Symptoms, and Burdens

EP: 2.Epinephrine First: The Proven First-Line Treatment for Anaphylaxis

EP: 3.Bridging the Barriers: What is Preventing Patients From Using Epinephrine

Now Viewing

EP: 4.An Opportunity for Innovation: Rethinking Unmet Needs in Epinephrine Administration

EP: 5.Nasal Epinephrine Spray: Review of Clinical Trial Results

EP: 6.Immediate Impact: Nasal Epinephrine Spray After Allergen Challenge

EP: 7.Safety Solidified: Results of Oral Food Challenge Trials With Nasal Epinephrine Spray

EP: 8.A Fit for Many: Storage, Shelf Life, and Ideal Patients

EP: 9.Transitioning to the Real-World: Expert Experiences with Nasal Epinephrine Spray

Barriers to Timely Epinephrine Use and Updated Guidelines

Multiple significant barriers prevent timely epinephrine use in anaphylaxis situations. Over 50% of patients don't consistently carry their epinephrine devices, approximately 40% fail to administer epinephrine when indicated, and more than 50% of parents report being afraid to give their child epinephrine even when they know it's needed. Even with proper training, 20% of patients still administer auto-injectable epinephrine incorrectly, while 70% make mistakes without adequate training.

An epidemic of epinephrine auto-injector underuse exists, as demonstrated by a 2018 survey of nearly 1,000 patients with allergies. Less than 90% filled their epinephrine prescriptions despite anaphylaxis risk, only 44% carried their devices consistently, and merely 25% carried more than one device. This represents a critical gap in anaphylaxis preparedness and emergency response capability.

Recent guidelines have evolved regarding post-epinephrine care, moving away from the previous mandate of immediate emergency department visits after any epinephrine use. Current practice parameters state that immediate emergency system activation may not be required if epinephrine is used promptly and the patient experiences rapid, durable, and significant symptom improvement. However, emergency care remains necessary for severe reactions with loss of consciousness, respiratory distress, slow symptom resolution, symptom recurrence, or when patients lack access to additional epinephrine doses or medical support.