title: Factory packed and expired - about emergency insect sting kits.
abstract: BACKGROUND
  Patients allergic to insect venom are instructed to always carry emergency medication-an emergency kit. According to the current guidelines, these emergency kits should contain a H1-receptor-blocking antihistamine and corticosteroid for oral use, as well as an epinephrine inhaler and in particular situations an epinephrine auto-injector.
  
  
  METHODS
  For quality management reasons patients with wasp venom allergy who presented for sting challenge provocation test were told to demonstrate their emergency kits. Concomitantly, constituents of the patient's emergency kits were checked for date of expiry of the medication and the patients were interviewed on storage and use of the emergency kits.
  
  
  RESULTS
  In total 42 patients with a median duration time of systemic immunotherapy of 2.5 year were evaluated. Medication post date of expiration was found in 54% of the kits (n = 39). Only 31% of the patients could demonstrate how to use the kits correctly. Problems were especially evident concerning for using the application of the inhaler and auto-injector. 50% of the patients demonstrated using epinephrine auto-injectors in such way that an accidental injection into the fingers would have resulted.
  
  
  CONCLUSIONS
  To assure safe and effective handling of all components of the emergency kit, continuous training and repeated supervised practice is necessary.
authors.affiliation: Department of Dermatology of the University Hospital of Tübingen, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Fischer
authors.forename: Björn
authors.initials: B
authors.lastname: Knaudt
authors.forename: Ulrich M
authors.initials: UM
authors.lastname: Caroli
authors.forename: Tilo
authors.initials: T
authors.lastname: Biedermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000517:prevention & control*; D000818:Animals; D001733:Bites and Stings / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D004349:Drug Packaging / Q000706:statistics & numerical data*; D004355:Drug Stability; D004356:Drug Storage; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005392:First Aid / Q000295:instrumentation* / Q000379:methods; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014863:Wasps; D055815:Young Adult