Global disparities in availability of epinephrine auto-injectors

Luciana Kase Tanno^{1

2

3

4}, Margitta Worm⁵, Motohiro Ebisawa⁶, Ignacio J Ansotegui⁷, Gianenrico Senna⁸, Stanley Fineman⁹, Mario Geller¹⁰, Alexei Gonzalez-Estrada¹¹, Dianne E Campbell¹², Agnes Leung¹³, Antonella Muraro¹⁴, Michael Levin¹⁵, Jose Antonio Ortega Martell¹⁶, Marco Caminati¹⁷, Pavel Kolkhir^{18

19}, Duy Le Pham²⁰, Razvigor Darlenski^{21

22}, Ignacio Esteban-Gorgojo²³, Manuel Rial²⁴, Ivana Filipovic²⁵, Sergio E Chiarella²⁶, Lyda Cuervo-Pardo²⁷, Christina Kwong²⁸, Cezar Fireth Pozo-Beltran²⁹, Tu Hk Trinh³⁰, Paul A Greenberger³¹, Paul J Turner³², Bernard Yu-Hor Thong³³, Bryan Martin³⁴, Victoria Cardona³⁵; WAO Anaphylaxis Committee and the WAO Junior Members Steering Group

Affiliations

¹ Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France.
² Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM, France.
³ WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.
⁴ Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France.
⁵ Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Germany.
⁶ Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.
⁷ Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
⁸ Department of Medicine, Allergy Asthma and Clinical Immunology Section, University of Verona, Verona, Italy.
⁹ Atlanta Allergy & Asthma, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁰ Section of Medicine of the Brazilian Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil.
¹¹ Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA.
¹² The University of Sydney, New South Wales, Australia.
¹³ The Chinese University of Hong Kong, Department of Pediatrics, Prince of Wales Hospital, Hong Kong Special Administrative Region of China.
¹⁴ Department of Mother and Child Health University of Padua Padua, Italy.
¹⁵ Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa.
¹⁶ Department of Immunology, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico.
¹⁷ Department of Medicine, University of Verona, Verona, Italy.
¹⁸ Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
¹⁹ Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
²⁰ Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet nam.
²¹ Department of Dermatology and Venereology, Acibadem City Clinic Tokuda Hospital Sofia, 51B Nikola Vaptsarov Blvd., 1407, Sofia, Bulgaria.
²² Department of Dermatology and Venereology, Trakia University-Stara Zagora, Stara Zagora, Bulgaria.
²³ Department of Allergy, Hospital General de Villalba, Madrid, Spain.
²⁴ Allergology Section, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
²⁵ University Hospital Dr Dragisa Misovic, Serbia.
²⁶ Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA.
²⁷ Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of Florida, USA.
²⁸ Phoenix Children's Hospital, Phoenix, AZ, USA.
²⁹ Hospital Infantil de México Federico Gómez, Mexico.
³⁰ Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet nam.
³¹ Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
³² National Heart & Lung Institute, Imperial College London, London, UK.
³³ Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
³⁴ Medicine and Pediatrics, The Ohio State University in Columbus, Ohio, USA.
³⁵ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, and ARADyAL Research Network, Spain.

PMID: 37915955
PMCID: PMC10616381
DOI: 10.1016/j.waojou.2023.100821

Global disparities in availability of epinephrine auto-injectors

Luciana Kase Tanno et al. World Allergy Organ J. 2023.

. 2023 Oct 20;16(10):100821.

doi: 10.1016/j.waojou.2023.100821. eCollection 2023 Oct.

Authors

Affiliations

¹ Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France.
² Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM, France.
³ WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.
⁴ Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France.
⁵ Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Germany.
⁶ Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.
⁷ Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
⁸ Department of Medicine, Allergy Asthma and Clinical Immunology Section, University of Verona, Verona, Italy.
⁹ Atlanta Allergy & Asthma, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁰ Section of Medicine of the Brazilian Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil.
¹¹ Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA.
¹² The University of Sydney, New South Wales, Australia.
¹³ The Chinese University of Hong Kong, Department of Pediatrics, Prince of Wales Hospital, Hong Kong Special Administrative Region of China.
¹⁴ Department of Mother and Child Health University of Padua Padua, Italy.
¹⁵ Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa.
¹⁶ Department of Immunology, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico.
¹⁷ Department of Medicine, University of Verona, Verona, Italy.
¹⁸ Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
¹⁹ Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
²⁰ Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet nam.
²¹ Department of Dermatology and Venereology, Acibadem City Clinic Tokuda Hospital Sofia, 51B Nikola Vaptsarov Blvd., 1407, Sofia, Bulgaria.
²² Department of Dermatology and Venereology, Trakia University-Stara Zagora, Stara Zagora, Bulgaria.
²³ Department of Allergy, Hospital General de Villalba, Madrid, Spain.
²⁴ Allergology Section, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
²⁵ University Hospital Dr Dragisa Misovic, Serbia.
²⁶ Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA.
²⁷ Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of Florida, USA.
²⁸ Phoenix Children's Hospital, Phoenix, AZ, USA.
²⁹ Hospital Infantil de México Federico Gómez, Mexico.
³⁰ Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet nam.
³¹ Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
³² National Heart & Lung Institute, Imperial College London, London, UK.
³³ Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
³⁴ Medicine and Pediatrics, The Ohio State University in Columbus, Ohio, USA.
³⁵ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, and ARADyAL Research Network, Spain.

PMID: 37915955
PMCID: PMC10616381
DOI: 10.1016/j.waojou.2023.100821

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.

Keywords: Adrenaline; Adrenaline auto-injector; Anaphylaxis; Epinephrine auto-injector; Management; Survey; Treatment; World allergy organization (WAO).

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Conflict of interest statement

The authors declare that they do not have any conflict of interests related to the contents of this article.

Figures

**Fig. 1**
Global availability of epinephrine auto-injectors according to the WAO anaphylaxis survey.

See this image and copyright information in PMC

References

1. Portier P., Richet C. De l’action anaphylactique de certains venins. C R Séances Soc Biol. 1902;54:170.
1. Turner P.J., Worm M., Ansotegui I.J., et al. WAO Anaphylaxis Committee. Time to revisit the definition and clinical criteria for anaphylaxis? World Allergy Organ J. 2019 Oct 31;12(10) - PMC - PubMed
1. Tanno L.K., Bierrenbach A.L., Simons F.E.R., et al. On behalf the Joint Allergy Academies. Critical view of anaphylaxis epidemiology: open questions and new perspectives. Allergy Asthma. Clin Immunol. 2018 Apr 4;14:12. - PMC - PubMed
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Global disparities in availability of epinephrine auto-injectors

Affiliations

Global disparities in availability of epinephrine auto-injectors

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources