D3.329 - Real-world shelf-life of adrenaline auto-injectors (AAIs) at pharmacy dispensing: Insights from six countries

Clinical guidelines for anaphylaxis universally recommend that patients at risk of anaphylaxis carry adrenaline auto-injectors (AAIs) at all times. Although AAIs are approved with a shelf life of 18–24 months (depending on dose and brand), the remaining shelf life at pharmacy dispensing is typically shorter due to e.g. distribution, purchasing, and storage processes. This reduction in shelf-life creates a hidden burden: patients and caregivers must replace devices more frequently, increasing costs, inconvenience, and the risk of carrying expired devices; factors that may compromise adherence and clinical outcomes. Despite its importance, real-world data on shelf life at dispensing remain limited.

A cross-sectional, point-in-time analysis was conducted to capture the remaining shelf life of AAIs at dispensing across six countries: the UK, Canada, Denmark, Sweden, Finland, and Norway. In 2025, structured surveys were completed by pharmacists (n=50 per country, except Sweden n=100; total n=350), who reported expiry dates and batch numbers for all AAIs in stock on the survey date. The remaining shelf life (in months) was calculated for each batch. 

Across all six countries, the remaining shelf life at dispensing was substantially shorter than the approved 18-24 months. Mean remaining shelf life ranged from 7 to 13 months, with notable variability by country and dose strength. These findings indicate that the effective usable period for AAIs in real-world settings is often less than half of the labelled shelf life, potentially increasing patient burden and the risk of carrying expired medication.

The observed real-world shelf life at pharmacy dispensing represents an under-recognised factor potentially influencing treatment adherence and continuity of care in anaphylaxis management. Longer shelf-life formulations could reduce patient burden, minimise waste, improve compliance with guideline recommendations, and potentially increase adoption of adrenaline stocking in public spaces. These findings establish a baseline for future longitudinal research and highlight shelf life as a critical parameter in optimising anaphylaxis care.