World Allergy Organization Journal (Oct 2023)
Global disparities in availability of epinephrine auto-injectors
- Luciana Kase Tanno, MD, PhD,
- Margitta Worm, MD, PhD,
- Motohiro Ebisawa, MD, PhD,
- Ignacio J. Ansotegui, MD, PhD,
- Gianenrico Senna, MD, PhD,
- Stanley Fineman, MD, PhD,
- Mario Geller, MD,
- Alexei Gonzalez-Estrada, MD,
- Dianne E. Campbell, MBBS, FRACP, PhD,
- Agnes Leung, MBChB,
- Antonella Muraro, MD, PhD,
- Michael Levin, MD, PhD,
- Jose Antonio Ortega Martell, MD, PhD,
- Marco Caminati, MD,
- Pavel Kolkhir, MD,
- Duy Le Pham, MD, PhD,
- Razvigor Darlenski, MD, PhD,
- Ignacio Esteban-Gorgojo, MD,
- Manuel Rial, MD, PhD,
- Ivana Filipovic, MD,
- Sergio E. Chiarella, MD,
- Lyda Cuervo-Pardo, MD,
- Christina Kwong, MD,
- Cezar Fireth Pozo-Beltran, MD,
- Tu HK. Trinh, MD, PhD,
- Paul A. Greenberger, MD,
- Paul J. Turner, FRCPCH, PhD,
- Bernard Yu-Hor Thong, MBBS, FRCP (Edin),
- Bryan Martin, MD,
- Victoria Cardona, MD, PhD
Affiliations
- Luciana Kase Tanno, MD, PhD
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM, France; WHO Collaborating Centre on Scientific Classification Support, Montpellier, France; Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France; Corresponding author. Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud, 34295 cedex 5, Montpellier, France.
- Margitta Worm, MD, PhD
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Germany
- Motohiro Ebisawa, MD, PhD
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
- Ignacio J. Ansotegui, MD, PhD
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
- Gianenrico Senna, MD, PhD
- Department of Medicine, Allergy Asthma and Clinical Immunology Section, University of Verona, Verona, Italy
- Stanley Fineman, MD, PhD
- Atlanta Allergy & Asthma, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Mario Geller, MD
- Section of Medicine of the Brazilian Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
- Alexei Gonzalez-Estrada, MD
- Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
- Dianne E. Campbell, MBBS, FRACP, PhD
- The University of Sydney, New South Wales, Australia
- Agnes Leung, MBChB
- The Chinese University of Hong Kong, Department of Pediatrics, Prince of Wales Hospital, Hong Kong Special Administrative Region of China
- Antonella Muraro, MD, PhD
- Department of Mother and Child Health University of Padua Padua, Italy
- Michael Levin, MD, PhD
- Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
- Jose Antonio Ortega Martell, MD, PhD
- Department of Immunology, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
- Marco Caminati, MD
- Department of Medicine, University of Verona, Verona, Italy
- Pavel Kolkhir, MD
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Duy Le Pham, MD, PhD
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet nam
- Razvigor Darlenski, MD, PhD
- Department of Dermatology and Venereology, Acibadem City Clinic Tokuda Hospital Sofia, 51B Nikola Vaptsarov Blvd., 1407, Sofia, Bulgaria; Department of Dermatology and Venereology, Trakia University-Stara Zagora, Stara Zagora, Bulgaria
- Ignacio Esteban-Gorgojo, MD
- Department of Allergy, Hospital General de Villalba, Madrid, Spain
- Manuel Rial, MD, PhD
- Allergology Section, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- Ivana Filipovic, MD
- University Hospital Dr Dragisa Misovic, Serbia
- Sergio E. Chiarella, MD
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
- Lyda Cuervo-Pardo, MD
- Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of Florida, USA
- Christina Kwong, MD
- Phoenix Children's Hospital, Phoenix, AZ, USA
- Cezar Fireth Pozo-Beltran, MD
- Hospital Infantil de México Federico Gómez, Mexico
- Tu HK. Trinh, MD, PhD
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet nam
- Paul A. Greenberger, MD
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA
- Paul J. Turner, FRCPCH, PhD
- National Heart & Lung Institute, Imperial College London, London, UK
- Bernard Yu-Hor Thong, MBBS, FRCP (Edin)
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
- Bryan Martin, MD
- Medicine and Pediatrics, The Ohio State University in Columbus, Ohio, USA
- Victoria Cardona, MD, PhD
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, and ARADyAL Research Network, Spain
- Journal volume & issue
-
Vol. 16,
no. 10
p. 100821
Abstract
Background: Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions and can cause death. Given the prevalence of anaphylaxis within healthcare systems, it is a high priority public health issue. However, management of anaphylaxis – both acute and preventative – varies by region. Methods: The World Allergy Organization (WAO) Anaphylaxis Committee and the WAO Junior Members Steering Group undertook a global online survey to evaluate local practice in the diagnosis and management of anaphylaxis across regions. Results: Responses were received from WAO members in 66 countries. While intramuscular epinephrine (adrenaline) is first-line treatment for anaphylaxis, some countries continue to recommend alternative routes in contrast to guidelines. Epinephrine auto-injector (EAI) devices, prescribed to individuals at ongoing risk of anaphylaxis in the community setting, are only available in 60% of countries surveyed, mainly in high-income countries. Many countries in South America, Africa/Middle-East and Asian-Pacific regions do not have EAI available, or depend on individual importation. In countries where EAIs are commercially available, national policies regarding the availability of EAIs in public settings are limited to few countries (16%). There is no consensus regarding the time patients should be observed following emergency treatment of anaphylaxis. Conclusion: This survey provides a global snapshot view of the current management of anaphylaxis, and highlights key unmet needs including the global availability of epinephrine for self-injection as a key component of anaphylaxis management.
