Global disparities in availability of epinephrine auto-injectors

• Type of Material: Article
• Authors: Luciana Kase Tanno, University of Montpellier; Margitta Worm, Universitätsmedizin Berlin; Motohiro Ebisawa, National Hospital Organization Sagamihara National Hospital; Ignacio J. Ansotegui, Hospital Quironsalud Bizkaia; Gianenrico Senna, University of Verona; Stanley Fineman, Emory University; Mario Geller, Brazilian Academy of Medicine of Rio de Janeiro; Alexei Gonzalez-Estrada, Mayo Clinic, Scottsdale; Dianne E. Campbell, University of Sydney; Agnes :eung, The Chinese University of Hong Kong; Antonella Muraro, University of Padua; Michael Levin, University of Cape Town; Jose Antonio Ortega Martell, Universidad Autónoma del Estado de Hidalgo; Marco Caminati, University of Verona; Pavel Kolkhir, Universitätsmedizin Berlin; Duy Le Pham, University of Medicine and Pharmacy at Ho Chi Minh City; Razvigor Darlenski, Trakia University, Stara Zagora; Ignacio Esteban-Gorgojo, Hospital General de Villalba; Manuel Rial, Universitario A Coruña; Ivana Filipovic, University Hospital Dr Dragisa Misovic; Sergio E. Chiarella, Mayo Clinic, Rochester; Lyda Cuervo-Pardo, University of Florida; Christina Kwong, Phoenix Children's Hospital; Cezar Fireth Pozo-Beltran, Hospital Infantil de México Federico Gómez; Tu HK Trinh, University of Medicine and Pharmacy at Ho Chi Minh City; Paul a. Greenberger, Northwestern University; Paul J. Turner, Imperial College London; Bernard Yu-Hor Thong, Tan Tock Seng Hospital; Bryan Martin, The Ohio State University; Victoria Cardona, Hospital Vall d'Hebron
• Language: English
• Date: 2023-10-20
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s). Published by Elsevier Inc. on behalf of World Allergy Organization.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016/j.waojou.2023.100821
• Title of Journal or Parent Work: World Allergy Organization Journal
• Volume: 16
• Issue: 10
• Start Page: 100821
• Grant/Funding Information: Luciana Kase Tanno received an unrestricted ANS grant through CHRUM administration and a research AllerGOS grant.
• Keywords: Survey; Treatment; World allergy organization; Adrenaline auto-injector; Management; Epinephrine auto-injector; Adrenaline; Anaphylaxis
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Immunology; Health Sciences, Pharmacology

Abstract

Background Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions and can cause death. Given the prevalence of anaphylaxis within healthcare systems, it is a high priority public health issue. However, management of anaphylaxis – both acute and preventative – varies by region. Methods The World Allergy Organization (WAO) Anaphylaxis Committee and the WAO Junior Members Steering Group undertook a global online survey to evaluate local practice in the diagnosis and management of anaphylaxis across regions. Results Responses were received from WAO members in 66 countries. While intramuscular epinephrine (adrenaline) is first-line treatment for anaphylaxis, some countries continue to recommend alternative routes in contrast to guidelines. Epinephrine auto-injector (EAI) devices, prescribed to individuals at ongoing risk of anaphylaxis in the community setting, are only available in 60% of countries surveyed, mainly in high-income countries. Many countries in South America, Africa/Middle-East and Asian-Pacific regions do not have EAI available, or depend on individual importation. In countries where EAIs are commercially available, national policies regarding the availability of EAIs in public settings are limited to few countries (16%). There is no consensus regarding the time patients should be observed following emergency treatment of anaphylaxis. Conclusion This survey provides a global snapshot view of the current management of anaphylaxis, and highlights key unmet needs including the global availability of epinephrine for self-injection as a key component of anaphylaxis management.