Epinephrine auto-injectors: first-aid treatment still out of reach for many at risk of anaphylaxis in the community.

BACKGROUND: Epinephrine (adrenaline) is an essential medication for the treatment of anaphylaxis. Epinephrine auto-injectors are universally recommended as first-aid treatment for anaphylaxis occurring in community settings. In a World Allergy Organization survey conducted in 2003, auto-injectors containing 0.3 mg of epinephrine were reported to be available in 56.4% of countries and those containing 0.15 mg of epinephrine were reported to be available in 43.6% of countries. Auto-injectors containing an infant dose were not available in any country. The cost of 1 auto-injector ranged from US $30 to US $110.

OBJECTIVE: To ascertain if availability and affordability of epinephrine auto-injectors had improved worldwide between 2003 and 2007.

METHODS: The survey instrument designed for use in 2003, with 2 additional questions, was self-administered by allergy/ immunology specialists in the 2007 World Allergy Organization House of Delegates. Responses were tabulated by country.

RESULTS: Completed surveys were received from 1 or more representatives of all 44 countries with voting delegates (100% response rate). At the time of the survey, auto-injectors containing 0.3 mg of epinephrine and auto-injectors containing 0.15 mg of epinephrine, were available through official distribution channels in 26 (59.1%) of 44 countries (95% confidence interval for percentage of countries, 43.2%-73.7%). Auto-injectors containing an infant dose were still not available in any country. The unsubsidized median cost of 1 auto-injector was US $97.87 (range, US $54.50-US $168.66).

CONCLUSIONS: Since 2003, the global availability of auto-injectors containing 0.3 mg of epinephrine has improved slightly. The availability of those containing 0.15 mg of epinephrine has improved more. Auto-injector costs have increased. The lack of availability and affordability of epinephrine auto-injectors for the first-aid treatment of anaphylaxis in the community remains a concern in many countries.