Patients’ ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial

Abstract

BackgroundPrevious work has shown patients commonly misuse adrenaline autoinjectors (AAI). It is unclear whether this is due to inadequate training, or poor device design. We undertook a prospective randomized controlled trial to evaluate ability to administer adrenaline using different AAI devices.MethodsWe allocated mothers of food‐allergic children prescribed an AAI for the first time to Anapen or EpiPen using a computer‐generated randomization list, with optimal training according to manufacturer's instructions. After one year, participants were randomly allocated a new device (EpiPen, Anapen, new EpiPen, JEXT or Auvi‐Q), without device‐specific training. We assessed ability to deliver adrenaline using their AAI in a simulated anaphylaxis scenario six weeks and one year after initial training, and following device switch. Primary outcome was successful adrenaline administration at six weeks, assessed by an independent expert. Secondary outcomes were success at one year, success after switching device, and adverse events.ResultsWe randomized 158 participants. At six weeks, 30 of 71 (42%) participants allocated to Anapen and 31 of 73 (43%) participants allocated to EpiPen were successful – RR 1.00 (95% CI 0.68–1.46). Success rates at one year were also similar, but digital injection was more common at one year with EpiPen (8/59, 14%) than Anapen (0/51, 0%, P = 0.007). When switched to a new device without specific training, success rates were higher with Auvi‐Q (26/28, 93%) than other devices (39/80, 49%; P < 0.001).Conclusions AAI device design is a major determinant of successful adrenaline administration. Success rates were low with several devices, but were high using the audio‐prompt device Auvi‐Q.

Epinephrine for First-aid Management of Anaphylaxis

“…Various EAs may come to market having different mechanisms of activation and variations in ease of use. 53,54 Education about anaphylaxis recognition and injection technique is advised to ensure familiarity with the specific device prescribed.…”

Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register

“…As a result, there is a need for training in when and how to use adrenaline in general, and more specifically autoinjectors, among patients, practitioners, and pharmacists [21,22,23,24,25,26]. The use of autoinjectors may be preferred for emergency use by health care professionals in some instances [27].…”

A systematic review of patients', parents' and healthcare professionals' adrenaline auto-injector administration techniques

“…The introduction of newer AAIs such as the next-generation EpiPen, Jext, Emerade and Auvi-Q may impact on future assessments, although the majority of these devices use the same/similar injecting mechanisms. The most recent study in this review compared AAI use between devices and found that when prescribed a new device without receiving specific training, successful administration rates for mothers were higher with Auvi-Q (an audio-prompt AAI) (93%) than other traditional devices (ie, EpiPen, Anapen, Jext) (49%) 15. It is likely that correct administration rates will increase if audio-prompt devices are made readily available.…”