title: Lack of worldwide availability of epinephrine autoinjectors for outpatients at risk of anaphylaxis.
abstract: BACKGROUND
  Anaphylaxis is increasing globally and often occurs in the community rather than in a health care setting. Epinephrine, the initial treatment of choice for anaphylaxis, is listed by the World Health Organization as an essential medication; however, the extent of its availability for outpatients is unknown.
  
  
  OBJECTIVE
  To determine the availability of epinephrine for use in the first-aid, out-of-hospital treatment of anaphylaxis in different countries.
  
  
  METHODS
  We used an investigator-designed, validated survey instrument that was self-administered by members of the World Allergy Organization House of Delegates for 2003 to 2005. Responses were tabulated by country.
  
  
  RESULTS
  Completed surveys were received from all 75 representatives of all 39 countries (100% response rate). At the time of the survey, epinephrine autoinjectors that contained a 0.25- or 0.3-mg dose appropriate for use in adults were available in 56.4% (95% confidence interval [CI], 40.8%-72%) of these countries. Widespread availability in Europe and availability in countries such as the United States, Canada, and Australia contrasted with limited availability in Asia, South America, and Africa. Autoinjectors that contained a 0.15-mg dose appropriate for use in some children were available in 43.6% (95% CI, 28%-59.2%) of the 39 countries. Autoinjectors that contained a dose appropriate for use in infants were not available in any country. Costs ranged from 30 US dollars to 110 US dollars. In 27.3% (95% CI, 8.7%-45.9%) of the countries, no financial assistance from government or private insurance was available to defray the cost.
  
  
  CONCLUSIONS
  This study raises concerns about lack of availability and affordability of epinephrine autoinjectors worldwide for individuals of all ages, especially for the pediatric population.
authors.affiliation: Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada. lmcniven@hsc.mb.ca
authors.forename: F Estelle R
authors.initials: FE
authors.lastname: Simons
mesh_terms: D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy / Q000191:economics*; D002648:Child; D003430:Cross-Sectional Studies; D004837:Epinephrine / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D005392:First Aid / Q000295:instrumentation; D014943:Global Health; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular / Q000295:instrumentation; D010045:Outpatients; D010290:Parents; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013594:Syringes / Q000191:economics / Q000600:supply & distribution*
chemical_list: D000318:Adrenergic beta-Agonists; D004837:Epinephrine