Incomplete and incorrect epinephrine auto-injector training to food-allergic patients by pharmacists in the Netherlands

Pediatr Allergy Immunol. 2017 May;28(3):238-244. doi: 10.1111/pai.12688. Epub 2017 Feb 6.


Background: Successful treatment of anaphylaxis in the community relies on early and correct use of epinephrine auto-injectors (EAI). In the Netherlands, pharmacists supply EAIs to patients and have a crucial role in instructing patients in how and when to use EAI. However, there are currently no data in Europe on the quality of such instruction provided by pharmacists. Therefore, the aims of this study were to investigate the knowledge, attitudes, and beliefs regarding food allergy among pharmacists in the Netherlands and to investigate the quality of EAI instructions and demonstrations to patients by pharmacists.

Methods: Pharmacists were asked to complete an online questionnaire. Quality of instructions and demonstration accuracy were assessed in mystery guest visits to randomly selected pharmacies. For the statistical analysis, descriptive methods were used.

Results: In total, 25 of 115 questionnaires were completed. Only two (8%) respondents gave correct answers concerning the proper EAI demonstration. Twenty-one (84%) respondents thought that the provision of instructions was the responsibility of pharmacists. In total, ten pharmacies were included in simulated patient visits. Five of them (50%) demonstrated the EAI. None of them demonstrated the EAI use correctly.

Conclusion: Food-allergic patients at high risk for anaphylaxis who receive their EAI from a community pharmacy are often not instructed on how to use an EAI or receive incorrect instructions. Pharmacists show considerable gaps in knowledge about food allergy and its management. These data suggest that opportunities exist to improve the quality of care provided by pharmacies to high-risk food-allergic patients.

Keywords: anaphylaxis; demonstration; epinephrine auto-injector; food allergy; pharmacies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anaphylaxis / drug therapy*
  • Epinephrine / administration & dosage*
  • Female
  • Food Hypersensitivity / drug therapy*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Patient Education as Topic / methods*
  • Pharmacists / statistics & numerical data*
  • Self Administration
  • Surveys and Questionnaires


  • Epinephrine