title: Epinephrine auto-injectors: first-aid treatment still out of reach for many at risk of anaphylaxis in the community.
abstract: 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.
authors.affiliation: Department of Pediatrics and Child Health, Canadian Institutes of Health Research National Training Program in Allergy and Asthma, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba. lmcniven@hsc.mb.ca
authors.forename: F Estelle R
authors.initials: FE
authors.lastname: Simons
mesh_terms: D000707:Anaphylaxis / Q000188:drug therapy*; D004837:Epinephrine / Q000008:administration & dosage* / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use; D005392:First Aid / Q000295:instrumentation* / Q000706:statistics & numerical data; D014943:Global Health; D006801:Humans; D007273:Injections, Intramuscular / Q000295:instrumentation / Q000706:statistics & numerical data; D004366:Nonprescription Drugs / Q000600:supply & distribution; D055553:Prescription Drugs / Q000600:supply & distribution; D011795:Surveys and Questionnaires; D013594:Syringes / Q000191:economics / Q000600:supply & distribution*
chemical_list: D004366:Nonprescription Drugs; D055553:Prescription Drugs; D004837:Epinephrine