D1.189 - An Analysis of Adrenaline Auto-Injector distribution in the Republic of Ireland between 2019 to 2023

Anaphylaxis is a severe, potentially life-threatening allergic reaction. International guidelines stipulate that intramuscular adrenaline is the first line treatment for anaphylaxis and recommend Adrenaline Autoinjectors (AAI) prescription to any patient at risk of anaphylaxis. Delay in the administration of adrenaline increases the risk of biphasic reaction, hospitalisation, and death. 

This study examined the distribution of AAIs in children between 0-18 years in the Republic of Ireland (ROI) by region between 2019 and 2023 using national prescription reimbursement scheme data. The number of AAIs per region was analysed by population, social deprivation index and proximity to a tertiary allergy centre.

There was a consistent increase in the prescribing of AAI in the period between 2019-2023 in Ireland for children aged 0-18 years of age. The highest prescription rate per paediatric population was seen in the capital city Dublin at 1%. Those living in closer proximity to an allergy centre were more likely to be prescribed an AAI. Allergists working outside the capital are responsible for higher numbers of individual children with AAIs on a population level.

Variation exists within the ROI for the prescribing of AAIs identifying a lack of health equity in access to allergy care across the country. Children living closer to a tertiary allergy centre were more likely to be prescribed an AAI. The lack of widespread allergy services in the ROI is a significant barrier to effective allergy care and is placing children at risk of poorer anaphylaxis outcomes due to lack of access to necessary AAIs. This study has identified the need for more access to allergy trained staff in all parts of the country focusing on the upskilling of primary and secondary care physicians in the areas furthest from allergy centres.