Deprescribing Self-Administered Epinephrine: Why, Who, and When?

Epinephrine is established as the first-line treatment for anaphylaxis. Self-administered epinephrine (self-epi) is widely prescribed to patients considered at higher risk of future reactions. However, ongoing provision of self-epi is not without consequences: there is a financial cost, and evidence suggests that self-epi has a negative impact on quality of life by reinforcing a patient's perception of vulnerability. The decision to prescribe or continue self-epi therefore requires balancing clinical evidence with patient preferences through shared decision making. Importantly, self-epi should not be considered permanent: individual risk can change over time due to natural resolution of food allergy, improved risk stratification, changes in comorbidities, or the effects of allergen immunotherapy. Although allergists are familiar with initiating self-epi, deprescribing is more complex. In this review, we outline clinical scenarios where deprescription may be appropriate, including after venom immunotherapy (where risk reduction is well established) and following food immunotherapy (where long-term outcomes are less certain). We also discuss psychosocial, economic, and medicolegal considerations that shape both patient and prescriber decision making. Deprescribing self-epi should be approached as a dynamic, individualized process that evolves with disease course and treatment milestones, always grounded in shared decision making.