Aims Anecdotally, there seems to be variation in the prescription of adrenaline autoinjectors to children following allergic reactions. The authors aimed to survey practice in this area and look at what factors influence the decision to prescribe.

Methods The authors developed a web-based survey containing 10 typical paediatric allergy case histories. A link for the website was emailed to tertiary paediatric allergy specialists and general paediatricians (including both those with and without a special interest in allergy). Respondents were asked to decide whether they would prescribe, not prescribe or offer patients and parents the choice of an epinephrine autoinjector in each case. They were also asked to choose from a list which factors had influenced their decision in each case. Respondents were also asked which relevant guidelines they had read.

Results The authors had a total of 38 respondents, 26 paediatric allergists (eight tertiary paediatric allergists and 18 general paediatricians with a special interest in allergy) and 12 general paediatricians. The majority (89.4%) of respondents had read at least one guideline. There was considerable variability in the decisions to prescribe in each case between respondents, though there was no significant difference between allergists and general paediatricians (except in the case of oral allergy syndrome). Factors significantly influencing the decision to prescribe or offer choice, rather than not prescribe, included nut allergy, reactions to a trace of the allergen, remote medical facilities and parental anxiety (depending on the nature of the case).

Conclusions There is considerable variability between paediatricians in the prescribing practice of Epinephrine autoinjectors. There are certain key factors than tend to influence the decision to prescribe or not. This study suggests the need for clearer, evidence-based guidance.