Simons FE; World Allergy Organization. Ann Allergy Asthma Immunol. 2009;102(5):403–409
PURPOSE OF THE STUDY. Epinephrine is a life-saving medication for the treatment of anaphylaxis, and epinephrine auto-injectors (EpiPen [Dey, Napa, CA] or Twinject [Sciele Pharma, Inc., Atlanta, GA]) are universally recommended as essential first-aid treatment for anaphylaxis. A survey conducted in 2003 at the World Allergy Organization (WAO) raised concerns regarding lack of universal availability and affordability of epinephrine auto-injectors in many countries. This study was conducted at the WAO meeting as a follow-up study to determine whether availability and affordability of epinephrine auto-injectors had improved worldwide between 2003 and 2007.
STUDY POPULATION. Participants included allergy and immunology specialists in the 2007 WAO House of Delegates.
METHODS. The same survey that was designed for use in 2003, with 2 additional questions, was self-administered at the 2007 WAO meeting. Responses were tabulated by country.
RESULTS. Completed surveys were received from ≥1 representative of all 44 countries with voting delegates (100% response rate). Auto-injectors containing 0.3 mg of epinephrine were available in 59.1% of countries, up from 56.4% in 2003, and auto-injectors containing 0.15 mg of epinephrine were available in 59.1% of countries, up from 43.6% in 2003. In no country were doses appropriate for infants available, in either 2003 or 2007. The unsubsidized median cost of 1 auto-injector was US $97.87 (range: $65.50–$168.66), up from $30 to $110 in 2003.
CONCLUSIONS. Since 2003, the global availability of auto-injectors containing 0.3 mg of epinephrine has improved slightly and the availability of those containing 0.15 mg of epinephrine has improved even more. Auto-injector costs have increased since 2003. The lack of availability and affordability of epinephrine auto-injectors remains a concern in many countries. Availability is especially limited in Asia, Africa, the Middle East, and Latin America.
REVIEWERS COMMENTS. It would be nice to follow this survey with other assessments of epinephrine availability (eg, polling more physicians and polling pharmacies), because the WAO physician population is not likely representative of the population at large. Although the accuracy of survey responses regarding availability or lack of availability was verified by contacting manufacturers, verification regarding accuracy of cost was not done. It is important to point out that the cost figures do not reflect what patients ultimately pay, because these figures do not factor in government subsidies or reductions from private health insurance. Importantly, this study finds that in no country was an appropriate infant dose available; this is obviously a problem for infants at risk for anaphylaxis. The authors also point out that, in more than one half of the countries in which epinephrine is available, it is not standard practice to recommend that people at risk for anaphylaxis carry 2 doses of epinephrine at all times. This is a potential concern, because up to 35% of anaphylaxis episodes occurring in the community are treated with ≥2 doses. Furthermore, because this study points out that global availability is relatively limited, physicians should encourage at-risk patients to travel with auto-injectors.
- Copyright © 2009 by the American Academy of Pediatrics