Gaps in knowledge and skills in pharmaceutical care for anaphylaxis

The increasing prevalence of anaphylaxis and its potentially fatal outcomes in cases of delayed recognition and treatment underscores the need for timely diagnosis and effective management. Pharmacists and pharmacy assistants, as highly accessible healthcare professionals, are well positioned to provide patient counseling and support the appropriate use of epinephrine autoinjectors (EAI). However, their preparedness within routine pharmaceutical care remains insufficiently investigated. This study aimed to assess the theoretical knowledge and practical competencies of pharmacists and pharmacy assistants in anaphylaxis recognition and management. A descriptive cross-sectional study was conducted between November 2025 and January 2026 among community pharmacists and pharmacy assistants in Latvia. Participation was voluntary. Data collection included a structured electronic questionnaire capturing demographic and professional characteristics, prior experience with anaphylaxis, and theoretical knowledge, alongside face-to-face practical skill assessments using an EAI training device and an eight-step evaluation checklist. Data were analyzed using IBM SPSS Statistics, applying descriptive statistics and non-parametric tests. The study was approved by the Ethics Committee of Rīga Stradiņš University (Protocol No. 2-PĒK-4/1073/2025). A total of 124 respondents completed the questionnaire (57.3% pharmacists, 42.7% pharmacy assistants). The majority were female (96.0%), with a median age of 34 years (IQR 28–41). Pharmacists had longer work experience ( p = 0.019). Experience with anaphylaxis and EAI use was limited; only 21.8% had attended relevant training, more often pharmacists than assistants (31.0% vs. 9.4%, p = 0.004). Most lacked practical experience with EAI training devices (69.4%), and their availability in pharmacies was low (4.0%). General knowledge was moderate, including better recognition of onset (86.3%) and occurrence without prior allergy (93.5%). However, clinically important gaps were identified, particularly regarding antihistamine use (38.7%) and indications for a second epinephrine dose (8.9%). In the practical assessment ( n = 147), no participant correctly performed all administration steps, and only 24.5% demonstrated correct initial steps. Median knowledge score was 6 (IQR 5–8) and was higher among younger participants, those with training, continuing education, patient contact, and EAI experience. Although participants demonstrated awareness of key principles of anaphylaxis recognition, preparedness for anaphylaxis management was limited by gaps in clinically relevant knowledge and practical EAI administration skills. These findings highlight substantial gaps in EAI use and emphasize the need for targeted, practice-oriented training to strengthen competencies in anaphylaxis recognition and management within pharmaceutical care. Not applicable.