title: How far from correct is the use of adrenaline auto-injectors? A survey in Italian patients.
abstract: Self-administered adrenaline through an auto-injector is the main out-of-hospital treatment for anaphylaxis, and patients should be trained to promptly and correctly use the device. The aim of the study was to verify the proper use of the device and the correct drug administration, and to identify possible misuse by patients. In seven Italian Allergy clinics, patients who were previously provided with self-injectable adrenaline were recruited at the follow-up visit required for the renewal of their prescription. All patients completed a questionnaire covering details of their allergic reactions, and knowledge of the device. The correct use was verified by the physician using a trainer with a four-step examination. 242 patients were included; 46 patients (18 %) did not always carry the auto-injector, and 35 patients (14 %) reported situations in which they were doubtful about whether to use adrenaline. Only 39 % of patients properly managed the device, while some patients (6 %) failed in all four steps. The majority of patients considered it appropriate to use adrenaline at the onset of respiratory symptoms (56 %). The factor most closely related to proper use of the device was the education of the patient (p = 0.03), while age and the time from first prescription did not affect the ability to properly use the auto-injector. Even though accurate training is conducted, many patients are still unable to properly use the adrenaline auto-injector in case of anaphylaxis. Allergists should review the instructions provided to the patients every time a renewal of the auto-injector is prescribed.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, via Gramsci 14, 43126, Parma, Italy. erminia.ridolo@unipr.it.
authors.forename: Erminia
authors.initials: E
authors.lastname: Ridolo
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, via Gramsci 14, 43126, Parma, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Montagni
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, via Gramsci 14, 43126, Parma, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bonzano
authors.affiliation: Allergy Unit, G. da Saliceto Hospital, Piacenza, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Savi
authors.affiliation: Allergy Unit, G. da Saliceto Hospital, Piacenza, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Peveri
authors.affiliation: Allergy Unit, Poma Hospital, Mantua, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Costantino
authors.affiliation: Allergology Service, Department of Medicine and Public Health, University of Padua, Padua, Italy.
authors.forename: Mariangiola
authors.initials: M
authors.lastname: Crivellaro
authors.affiliation: Allergy Outpatients Service, General Hospital, Treviglio, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Manzotti
authors.affiliation: Allergy and Immunology Unit, Department of Internal Medicine, Sant'OrsolaPoliambulanza Hospital, Brescia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.affiliation: Allergy Unit, Verona University Hospital, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Caminati
authors.affiliation: Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, Italy.
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Incorvaia
authors.affiliation: Allergy Unit, Verona University Hospital, Verona, Italy.
authors.forename: Gianenrico
authors.initials: G
authors.lastname: Senna
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000517:prevention & control*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004522:Educational Status; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007273:Injections, Intramuscular; D007558:Italy; D008297:Male; D012646:Self Administration / Q000295:instrumentation*; D011795:Surveys and Questionnaires
chemical_list: D001993:Bronchodilator Agents; D004837:Epinephrine
keywords: Adrenaline; Anaphylaxis; Auto-injector