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Ability to successfully use an epinephrine auto-injector after switching to a different device

Rationale

Patients previously prescribed one epinephrine auto-injector device may be switched to an alternative device by their pharmacist or physician - sometimes without training on the new device. It is unclear whether “device switches” without retraining compromise the ability to deliver epinephrine.

Methods

We evaluated mothers of food-allergic children participating in a UK study of epinephrine auto-injectors (EAI), 1 year after they were first trained to use an EAI, either Anapen or Epipen (old design). Participants' ability to deliver epinephrine using their device was assessed using a simulated anaphylaxis scenario. Participants then underwent repeat assessment using a different EAI device, randomly allocated, without training on the new device. The UK-approved EAIs Epipen (new/old designs), JEXT or Anapen were used, or Intelliject, an EAI with audio/visual prompts approved in North America as AuviQ(tm) and AllerjectTM. ISRCTN29175528

Results

We evaluated ability to deliver epinephrine in 108 participants. Overall success rates were similar using their original EAI 68/108 (63%) to the new device 65/108 (60%; P=0.775). However the outcome differed significantly for different types of device switch. Success rates were lower when switching between Anapen and either old Epipen, new Epipen or JEXT (6/18; 33%) compared with switching from old Epipen to either new Epipen or JEXT (30/42; 71%; P<0.009). Success rates were highest when switching from Anapen or old Epipen to Intelliject (26/28; 93%) compared with switching to other EAIs (39/80; 49%; P=0.000).

Conclusions

The safety of EAI device switches varies according to the specific device. Switches to Intelliject appear to be safer than other forms of device switch.

Author information

Correspondence to Robert Boyle.

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Keywords

  • Public Health
  • Success Rate
  • Epinephrine
  • Specific Device
  • Device Switch