title: Patients' ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial.
abstract: BACKGROUND
  Previous work has shown patients commonly misuse adrenaline autoinjectors (AAI). It is unclear whether this is due to inadequate training, or poor device design. We undertook a prospective randomized controlled trial to evaluate ability to administer adrenaline using different AAI devices.
  
  
  METHODS
  We allocated mothers of food-allergic children prescribed an AAI for the first time to Anapen or EpiPen using a computer-generated randomization list, with optimal training according to manufacturer's instructions. After one year, participants were randomly allocated a new device (EpiPen, Anapen, new EpiPen, JEXT or Auvi-Q), without device-specific training. We assessed ability to deliver adrenaline using their AAI in a simulated anaphylaxis scenario six weeks and one year after initial training, and following device switch. Primary outcome was successful adrenaline administration at six weeks, assessed by an independent expert. Secondary outcomes were success at one year, success after switching device, and adverse events.
  
  
  RESULTS
  We randomized 158 participants. At six weeks, 30 of 71 (42%) participants allocated to Anapen and 31 of 73 (43%) participants allocated to EpiPen were successful - RR 1.00 (95% CI 0.68-1.46). Success rates at one year were also similar, but digital injection was more common at one year with EpiPen (8/59, 14%) than Anapen (0/51, 0%, P = 0.007). When switched to a new device without specific training, success rates were higher with Auvi-Q (26/28, 93%) than other devices (39/80, 49%; P < 0.001).
  
  
  CONCLUSIONS
  AAI device design is a major determinant of successful adrenaline administration. Success rates were low with several devices, but were high using the audio-prompt device Auvi-Q.
authors: Section of Paediatrics, Imperial College London, London, UK.|Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
authors: T
authors: T
authors: Umasunthar
authors: Section of Paediatrics, Imperial College London, London, UK.|Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
authors: A
authors: A
authors: Procktor
authors: Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.|Academic Unit of Child and Adolescent Psychiatry, Imperial College London, London, UK.
authors: M
authors: M
authors: Hodes
authors: Population Health Research Institute, St. George's, University of London, London, UK.
authors: J G
authors: JG
authors: Smith
authors: Section of Paediatrics, Imperial College London, London, UK.|Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
authors: C
authors: C
authors: Gore
authors: Section of Paediatrics, Imperial College London, London, UK.|Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
authors: H E
authors: HE
authors: Cox
authors: Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
authors: T
authors: T
authors: Marrs
authors: Section of Paediatrics, Imperial College London, London, UK.|Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
authors: H
authors: H
authors: Hanna
authors: Section of Paediatrics, Imperial College London, London, UK.|Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
authors: K
authors: K
authors: Phillips
authors: Section of Paediatrics, Imperial College London, London, UK.|Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
authors: C
authors: C
authors: Pinto
authors: Section of Paediatrics, Imperial College London, London, UK.
authors: P J
authors: PJ
authors: Turner
authors: Section of Paediatrics, Imperial College London, London, UK.|Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
authors: J O
authors: JO
authors: Warner
authors: Section of Paediatrics, Imperial College London, London, UK.|Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
authors: R J
authors: RJ
authors: Boyle
mesh_terms: D000707:Anaphylaxis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005512:Food Hypersensitivity / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007267:Injections; D008297:Male; D012469:Salivary Glands / Q000378:metabolism; D055291:Salivary alpha-Amylases / Q000378:metabolism; D012646:Self Administration; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D000516:alpha-Amylases
chemical_list: D014662:Vasoconstrictor Agents; D055291:Salivary alpha-Amylases; D000516:alpha-Amylases; D004837:Epinephrine
keywords: adrenaline; anaphylaxis; autoinjector; food allergy; human factors research