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Getting Teenagers with Food Allergy to Carry their Epinephrine Auto-Injectors: Do Financial Incentives Pay Off?

January 23, 2023

IgE-mediated food allergies can be life-threatening, requiring urgent treatment with an epinephrine auto-injector (EAI) device. Unfortunately, many adolescents with serious food allergies do not carry their EAI. Is there anything we can do to convince these teens to carry the EAI? 

Dupuis et al (10.1542/peds.2022-058876) share with us an interesting experiment in behavioral economics in which they randomized 131 adolescents ages 15 to 19 years with documented food allergy and an EAI into two intervention groups and a control group. One intervention group received frequent text message reminders to carry their EAI with them at all times and the other intervention group also got the text reminders and a financial incentive that would decline in monetary value every time they were spot-checked and did not have the EAI with them. The spot-check involved a random request for photo documentation.

The results of the 2 interventions may surprise you. For example, teens who got just the text messages actually complied with carrying their EAI less than the control group. Teens who got the monetary incentive with the texts did twice as well as the control group (45% vs 23% EAI compliance), but that still meant half of those in the intervention had the EIR nearby more than 50% of the time.

So why are the results so disappointing and what can be done about it? The authors provide some interesting thoughts as well as review the limitations of their unique methodology in the discussion section of their article. There is plenty of hypoallergenic food for thought to be digested when you link to this article and learn more.

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