Study Finds Supervised Self-Injection With Empty Syringes Improved Comfort in Food-Allergic Adolescents Administering Epinephrine
Researchers from the Icahn School of Medicine at Mount Sinai have found that supervised self-injection with empty syringes makes many food-allergic adolescents and their parents more comfortable with using the life-saving devices. The results were published on March 7 in The Journal of Allergy and Clinical Immunology: In Practice.
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.
The study was funded as a part of the EMPOWER (Enhancing, Managing, and Promoting Well-being and Resiliency) program within The Elliot and Roslyn Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai, and by the Jaffe Family Foundation, Vanech Family Foundation, and The Pine/Segal families.
About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.
The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is in the "Honor Roll" of best hospitals in America, ranked No. 15 nationally in the 2016-2017 "Best Hospitals" issue of U.S. News & World Report. The Mount Sinai Hospital is also ranked as one of the nation's top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai's Kravis Children's Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals."