Autoinjector models
We identified seven randomised trials, two non-randomised controlled
trials and one consecutive case series examining the usability of
autoinjectors (supplement S5h). These encompassed heterogeneous types of
autoinjectors and testers, including those at risk of anaphylaxis,
healthy volunteers and healthcare professionals.
Some studies explored modifying autoinjectors, such as changing the
colour of the safety cap, having an arrow pointing to the injection tip
or using voice prompts to guide people through their use. Such
modifications may slightly increase the proportion of people correctly
using the devices (low certainty)11Arga M, Bakirtas A, Topal E,
Yilmaz O, Hacer Ertoy Karagol I, Demirsoy MS, Turktas I. Effect of
epinephrine autoinjector design on unintentional injection injury.
Allergy Asthma Proc 2012;33(6):488-492.,22Bakirtas
A, Arga M, Catal F, Derinoz O, Demirsoy MS, Turktas I. Make-up of the
epinephrine autoinjector: the effect on its use by untrained users.
Pediatr Allergy Immunol 2011;22(7):729-733.,33Umasunthar
T, Procktor A, Hodes M, Smith JG, Gore C, Cox HE, Marrs T, Hanna H,
Phillips K, Pinto C, Turner PJ, Warner JO, Boyle RJ. Patients’ ability
to treat anaphylaxis using adrenaline autoinjectors: a randomized
controlled trial. Allergy 2015;70(7):855-863.,44Robinson
MN, Dharmage SC, Tang ML. Comparison of adrenaline auto-injector
devices: ease of use and ability to recall use. Pediatr Allergy
Immunol 2014;25(5):462-467.,55Guerlain S,
Hugine A, Wang L. A comparison of 4 epinephrine autoinjector delivery
systems: usability and patient preference. Ann Allergy Asthma Immunol
2010;104(2):172-177. and decrease the time taken to administer
adrenaline (low certainty).66Arga M, Bakirtas A, Topal E, Yilmaz
O, Hacer Ertoy Karagol I, Demirsoy MS, Turktas I. Effect of
epinephrine autoinjector design on unintentional injection injury.
Allergy Asthma Proc 2012;33(6):488-492.,77Bakirtas
A, Arga M, Catal F, Derinoz O, Demirsoy MS, Turktas I. Make-up of the
epinephrine autoinjector: the effect on its use by untrained users.
Pediatr Allergy Immunol 2011;22(7):729-733.
It is unclear whether specific autoinjector models reduce the risk of
unintentional injuries because the certainty of evidence is very low.
Two trials in adults found that a modified EpiPen was associated with a
18% or 40% reduction in unintentional injuries compared to the ‘old’
EpiPen (very low certainty, statistically significant, confidence
intervals not reported).88Arga M, Bakirtas A, Topal E, Yilmaz O,
Hacer Ertoy Karagol I, Demirsoy MS, Turktas I. Effect of epinephrine
autoinjector design on unintentional injection injury. Allergy Asthma
Proc 2012;33(6):488-492.,99Bakirtas A, Arga
M, Catal F, Derinoz O, Demirsoy MS, Turktas I. Make-up of the
epinephrine autoinjector: the effect on its use by untrained users.
Pediatr Allergy Immunol 2011;22(7):729-733. Another trial in mothers
of children at risk of anaphylaxis found that Anapen was associated with
a 14% decrease in unintentional injuries compared to EpiPen (very low
certainty, statistically significant, CI not reported).1010Umasunthar
T, Procktor A, Hodes M, Smith JG, Gore C, Cox HE, Marrs T, Hanna H,
Phillips K, Pinto C, Turner PJ, Warner JO, Boyle RJ. Patients’ ability
to treat anaphylaxis using adrenaline autoinjectors: a randomized
controlled trial. Allergy 2015;70(7):855-863.