Prescribing Epinephrine

Local members of the Indiana Allergy Society had a journal club this past Monday evening. It was a gathering of about 12 physicians. There were three allergists from Riley- who only see children and others who see a mix of adults and children. Those who devote their practice primarily to children did have a different perspective on the discussion.

This meeting was unique in another respect. It was the only time that I have ever been at a ‘journal club’ where no journal or article from a journal was presented. That was an interesting concept.

The intent was to discuss the prescribing of injectable epinephrine- Epi-pens and Auvi-Q. This followed a format used at the recent College of Allergy. Cases were presented, we voted as to whether or not we would give a prescription for epinephrine, and we argued our positions.

Most of the time there was consensus. When there was not, it differed depending upon the primary specialy- pediatrics vs. internal medicine. Even between those who are pediatricians there were differences.

As I try to categorize the general responses to the question, I would have the following;

  • Prescribe epinephrine to everyone you see in clinic with a food allergy, insect allergy, or on immunotherapy
  • Practice as if you were in a courtroom – trying to stay away from any litigation- the old ‘what if’ issue
  • Abide by practice parameters and guidelines

We talked about Food Allergy Action Plans- A point that I made was that these plans may differ from what we would have the school do and what we may have a family do. When the child is at school, he is away from those who know him best. He is in the hands of strangers who may vary in their competence to respond and hence a parent’s confidence regarding how to handle suspected vs. actual ingestion of a food. My perspective is to be more aggressive with these plans when the child is not with the parents. I will give the parents more leeway.

It was an animated discussion. It was a great opportunity to share perspectives. Importantly, it will stimulate us to look at these situations.

One point that I made a few times is that medicine is a mix of art and science. The science or evidence may lead to one decision whereas the art of medical practice would have us do something different. It still goes back to that part of the Hippocratic oath that says … above all, do no harm (? exact context).

FEL 4-17-2013


April 17, 2013 В· fleickly В· No Comments
Tags: , ,  В· Posted in: Anaphylaxis, Injectable Epinephrine, Medications used to treat allergy

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