Number Of Epipen Prescriptions for Kids Skyrockets Interview with:
Lavanya Diwakar, FRCPath

Honorary consultant in immunology
Queen Elizabeth Hospital, Birmingham, and
Research fellow in health economic
University of Birmingham
Birmingham UK What is the background for this study?

Response: The rate of anaphylaxis (serious, potentially life threatening manifestation of allergy) has increased in the last decade. There have been some reports from other countries about an increase in the number of adrenaline autoinjectors being prescribed in children, but this has not been systematically examined in the UK.
We looked at a database of patient records from over 500 general practices, THIN (the Health Improvement Network), between 2000 and 2012. We found nearly 24,000 children who had been identified as being at risk of anaphylaxis by General Practitioners and prescribed epipens. What are the main findings?

Response: Over the 12 year period the number of children identified by GPs as being at risk increased three and a half times, and the total number of devices prescribed (per 1000 person years) in the UK increased five-fold.
As the devices require annual renewal, and as per the estimates in the study, the cost to the tax payer could be as much as £7 million per year (just for children under the age of 18). What should readers take away from your report?

Response: There is a lot of variation currently in the way that these devices are prescribed in the UK. It appears that GPs are tending to prescribe more than 4 devices per child per year. There is no evidence that an increased number of devices (beyond 2) per child is necessary for improved safety.

The diagnosis which prompted the prescription of the adrenaline devices was not clear in about 50% of the children in our study. It is possible, therefore, that some of these devices were given to some children who did not need them. This can cause an unnecessary stress to the families.

We therefore feel that there should be a rational discussion about the prescription of these devices in the UK. What recommendations do you have for future research as a result of this study?

Response: It would be useful to know how many of the devices prescribed are being used. Research which helps us better understand which children are at high risk of anaphylaxis can also be very useful.
Disclosures:  This work funded by a fellowship awarded by the Wellcome Trust . Thank you for your contribution to the community.


Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study
Lavanya Diwakar, Carole Cummins, Ronan Ryan, Tom Marshall and Tracy Roberts
Br J Gen Pract 13 March 2017; bjgp17X689917. DOI:
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Last Updated on March 17, 2017 by Marie Benz MD FAAD