Anaphylaxis and epinephrine auto-injector training: who will teach the teachers?

Anaphylaxis is the most urgent clinical immunologic event. Effective treatment is best achieved by administration of epinephrine. Accidental exposure to the responsible allergen is the most common cause of anaphylaxis, and because it could be fatal within minutes, epinephrine in preloaded syringes and auto-injectors has been introduced. In our experience patients and medical personnel are not familiar with the use of this device.

We sought to assess community-based professionals' knowledge of epinephrine auto-injector use and their ability to educate patients.

Study participants consisted of a medical convention's delegates and emergency department personnel in metropolitan Toronto, as well as pharmacists of the target hospitals and retail pharmacists. Research assistants approached eligible professionals to fill out a questionnaire and demonstrate their ability to use a standard placebo auto-injector trainer.

A total of 122 professionals (composed of emergency physicians, family practitioners, and pediatricians) consented to participate in this study. The majority of participants (81%) did not have a placebo trainer to educate their patients; 76% did not know the 2 available dose strengths. To provide instructions and reinforcement, physicians clearly must have the necessary skills and knowledge, yet only 25% of the study participants were able to demonstrate the 3 steps of injection correctly.

Our study highlights a specific and important deficiency in medical professionals' care of patients at risk for anaphylaxis. The results challenge the current methods of educating professionals, as well as patients, when prescribing or using epinephrine auto-injectors. Clearly a new approach to educating and maintaining such skills is required.