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Information for healthcare professionals in Sweden only.

Do patients know how to use adrenaline auto-injectors?

Carneiro-Leão, L. et al. Do patients know how to use adrenaline auto-injectors? Food Allergy and Anaphylaxis Meeting (FAAM) 2016, Rome. Oral Abstract Session; OP05


Adrenaline auto-injectors (AAI) are the first line treatment for anaphylaxis in community settings. Two are currently available in Portugal (Anapen® and Epipen®).


To evaluate patient´s ability to properly use AAIs; impact of device switching and patients’ preferences.


Patients who had been prescribed an AAI in our department were invited to demonstrate correct technique of AAI by simulating adrenaline administration using training devices.

First, simulation with their prescribed AAI; second, evaluation of device switching, without any previous training, by simulating injection with a different AAI (Epipen® or Anapen®, as well as Emerade®- currently unavailable in Portugal).

Finally, they were asked which device they liked the best.


Thirty-two patients were enrolled, 16 (50%) females, with a mean (SD) age of 42.9 (±15.8) years; 18 (56%) with hymenoptera venom allergy and 14 (44%) food allergy.

Anapen® was prescribed to 15 (47%) and Epipen® to 17 (53%). Six did not acquire any AAI; 21 (66%) admitted carrying it on a daily basis.

Eleven (34%) could not demonstrate successful adrenaline administration with their prescribed AAI, 5 with Anapen® and 6 with Epipen®.

Nine (60%) of the 15 patients who were prescribed an Anapen® could not administer adrenaline with an Epipen®; 11 (65%) of the 17 with a prescribed Epipen® were unable to use an Anapen®. Only 2 (6%) were incapable of properly managing an Emerade®.

The most common error in patients switching from Epipen® to Anapen® was not removing the needle cap (9 patients). In the group switching Anapen® to Epipen®, the most common misuse was not massaging the injection site (10 patients); 6 tried to remove the orange tip as if it was a cap.

The preferred AAI was Emerade® in 20 (63%) and Epipen® in 12 (37%).


Patients at-risk for anaphylaxis are provided with portable auto-injectors, educated and trained on their use. One-third of the patients did not always carry them.

More than one-third was unable to successfully demonstrate adrenaline administration with their prescribed AAI.

Almost two-thirds failed to simulate injection when switched to the alternative one available in Portugal without any training.

Design appears to play a role in a successful switch since 94% of the patients changing from either Anapen® or Epipen® to Emerade® were able to correctly use it. It was also the overall preferred auto-injector.

These emergency medical devices should be patient friendly.

Read more

Accuracy in use of adrenaline auto-injectors in a simulated emergency situation: a comparison of Jext, EpiPen and Emerade by Dr. Knibb

Emerade adrenaline auto-injector

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