In part 2, Lieberman discusses why caregivers hesitate to use epinephrine and what system-level changes could close the gap in infants and toddlers.
Reframing when caregivers reach for epinephrine and expanding stock epinephrine access could meaningfully reduce delayed treatment in infants and toddlers with
Underuse spans every age group, but infants and toddlers are treated less often than older children during confirmed reactions.1 A recent review by Leeds and colleagues found 48% of caregivers withheld epinephrine because they did not believe symptoms were severe enough.²
"Infants shouldn't be treated any differently," Lieberman told HCPLive. "If we think they're having anaphylaxis, they should get epinephrine."
Hands-on exposure appears to move the needle more than instruction alone, Lieberman said. Parents who watch a clinician administer epinephrine during a supervised food challenge report greater comfort using an autoinjector on their own later.
Education emphasizing that standard auto-injector doses are not harmful, paired with a written anaphylaxis action plan, was also associated with higher caregiver willingness to treat. However, Lieberman noted randomized evidence directly testing action plans remains limited.
Many underestimate symptom severities, and a review found 48% of caregivers withheld treatment for this reason.
Undesignated epinephrine kept on-site, at a school for example, that can be administered to any child during a suspected reaction regardless of a known allergy diagnosis.
Lieberman said community caregivers, including daycare staff, school nurses, and camp staff, represent a persistent education gap, with no single delivery method proven superior among clinician-led sessions, video training, and parent-volunteer programs. The intervention Lieberman flagged as highest yield is stock epinephrine, now reflected in allergy practice parameters, which allows a dose to be given to any child regardless of known allergy history.
“It's the same idea as having defibrillators in stadiums that anyone can use if someone has a heart attack,” Lieberman said.
Lieberman added that awareness should keep pace with early allergen introduction guidance, since earlier peanut and other allergenic food exposure may increase reaction frequency in the populations reviewed.3
Reported disclosures for Lieberman include AQUESTIVE THERAPEUTICS, Genentech USA, kaleo, Bayer Healthcare, ABBVIE, BioCryst US Sales Co, and Amgen.
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