A number of different allergens have been reported to cause anaphylaxis, including foods, insect venom, latex, and medications. The symptoms of anaphylaxis include urticaria/angioedema, asthma symptoms, gastrointestinal upset, shock and even death. The preferred treatment of anaphylaxis is epinephrine, which is given as an intramuscular injection. Epinephrine is the only treatment for anaphylaxis that has been shown to reduce the chance of death, particularly when it is administered early.
For people who are at risk for anaphylaxis from severe allergies, epinephrine must be readily available to treat a severe allergic reaction. Epinephrine auto-injectors have been available for a number of years, with the most popular form being the Epi-Pen. The Epi-Pen is a device shaped like a writing pen, with a safety cap on one end and a spring-loaded needle on the other end. In order to activate the Epi-Pen, the safety cap must be removed and the end with the spring-loaded needle pressed against the thigh. Unfortunately, it is common for people attempting to use the Epi-Pen to hold it backwards, resulting in unintentional injections into the thumb — which is both painful and does not allow for appropriate absorption of epinephrine into the body in order to treat the symptoms of anaphylaxis.
More recently, a new type of epinephrine auto-injector was developed, called Auvi-Q. Auvi-Q incorporates a safety tab mechanism on the needle end of the device, and uses a voice prompt system that provides step-by-step instructions on how to use the device in order to prevent accidental needle sticks. Unlike the Epi-Pen, Auvi-Q is a small rectangular shaped device, approximately the size of a credit card.
A recent study sought to determine which device, Epi-Pen or Auvi-Q, is preferred by people who need to carry an epinephrine auto-injector for the treatment of anaphylaxis. Nearly 700 people of various ages and backgrounds participated in the study, published in 2013. Participants were given a scenario in which they pretended to be experiencing anaphylaxis that would require the use of an epinephrine auto-injector. They were then given a training version of each device (that did not contain a needle or actual epinephrine) and asked to figure out how to use the device. After the scenario was complete, the participants were asked about their preference of one device versus the other.
Surprisingly, the Auvi-Q was preferred, nearly 4 to 1, over the Epi-Pen in nearly every aspect of the comparison. These preferences included the method of instruction, preference of which device to carry, and the size and shape of the device. Participants also found the Auvi-Q much easier to use, easier to carry, easier to follow the instructions, and was preferred overall when compared to the Epi-Pen. Most importantly, participants were more often able to use the Auvi-Q correctly (81%) compared to the Epi-Pen (61%).
As a practicing allergist, I find the results of this study somewhat unbelievable. First of all, the company that makes the Auvi-Q device paid for the study – this nearly invalidates the study in my opinion. This not only makes the authors of the study biased toward the Auvi-Q, it may make the participants biased toward the Auvi-Q as well (since participants are often paid for their opinions, and may have known that they were being paid by the manufacturer of the new device). Next, I have evaluated both devices myself, and would think that the Epi-Pen would be preferable over the Auvi-Q based on my experience as an allergist treating anaphylaxis. Lastly, whenever a study such as this shows such a big difference between two groups, I think the study becomes less believable.
Therefore, while there may be a time when I will prescribe Auvi-Q, I prefer to prescribe the Epi-Pen for my patients who are at risk for anaphylaxis. Of note, I am not being paid by the company that manufacturers either device.
Camargo CA, Guana A, Wang S, Simons FER. Auvi-Q Versus Epi-Pen: Preferences of Adults, Caregivers, and Children. J Allergy Clin Immunol: In Practice. 2013;1:266-72.
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