When should self-injectible epinephrine be prescribed for food allergy and when should it be used?

PURPOSE OF REVIEW: To explore why epinephrine autoinjectors have failed to prevent fatal food anaphylaxis and how this problem might be solved.

RECENT FINDINGS: Autoinjectors cannot save lives when they are used too late, misused, not carried, or when an inadequate dose is absorbed; food allergy-induced asthma may not respond when asthma management is suboptimal. New markers for severe reactions have been published.

SUMMARY: The fallibility of autoinjectors means that in the management of food allergy, their provision must take second place to accurate identification of the trigger foods, optimal avoidance, and optimal treatment of other medical conditions that make reactions more dangerous.