Anaphylaxis and epinephrine autoinjectors: use, access, and disparities in health care in Brazil and worldwide

Anaphylaxis is a potentially fatal systemic hypersensitivity reaction for which intramuscular epinephrine is the first-line treatment. This review aimed to analyze the use of and access to epinephrine autoinjectors, emphasizing disparities between Brazil and other countries. A qualitative narrative literature review was conducted using clinical guidelines, epidemiological studies, international surveys, and institutional and regulatory documents. The findings revealed substantial inequalities in autoinjector availability, associated with economic, regulatory, and healthcare barriers. An international survey involving 66 countries reported device availability in 60% of participating countries, predominantly in higher-income settings. In Brazil, 5,716 anaphylaxis-related hospitalizations were recorded between 2011 and 2019. The Brazilian Anaphylaxis Registry, comprising 237 patients, documented epinephrine administration in 61.1% of cases, including autoinjector use in 8.4%. Regulatory restrictions and dependence on importation further complicated access during the periods examined. However, available evidence does not establish the individual contribution of these barriers to treatment outcomes. Ensuring effective access requires more than device commercialization, encompassing appropriate prescription, affordability, patient training, and continuity of care. Strengthening epidemiological surveillance and developing equitable access strategies remain important priorities.