Knowledge level of anaphylaxis management and epinephrine use among health professionals: a cross-sectional evaluation of audiologists

Year 2026, Volume: 8 Issue: 2, 351 - 357, 10.03.2026

Fatih Kaplan , Bilge Kurnaz Kaplan , Abdulgani Gülyüz

https://doi.org/10.38053/acmj.1883497

https://izlik.org/JA76CR42RM

Abstract

Aims: Anaphylaxis is a severe systemic hypersensitivity reaction with sudden onset and rapid progression that can be fatal if early intramuscular epinephrine is not administered. Although audiologists frequently work with pediatric and allergic patient populations, their competence in recognizing and managing anaphylaxis has not been systematically evaluated. The aim of this study was to assess audiologists’ knowledge levels regarding anaphylaxis, to identify critical life-saving knowledge gaps, and to determine independent predictors of correct epinephrine and auto-injector use.
Methods: In this cross-sectional study, 189 audiologists completed a 22-item knowledge questionnaire covering the definition of anaphylaxis, triggers, clinical manifestations, first-line treatment, epinephrine administration route and dose, and auto-injector use. A total knowledge score (range: 0-22) was calculated. Three critical outcomes were analyzed separately: knowledge that epinephrine is the first-line treatment for anaphylaxis, knowledge that epinephrine should be administered intramuscularly, and knowledge of the correct epinephrine dose (0.01 mg/kg). Independent predictors were evaluated using multivariable logistic regression analysis.
Results: The median total knowledge score was 12 (range: 1-22), and the internal consistency of the questionnaire was good (Cronbach’s α=0.793). Only 50.8% of participants correctly identified epinephrine as the first-line treatment for anaphylaxis, 34.4% knew that epinephrine should be administered intramuscularly, and 42.9% knew the correct epinephrine dose. Awareness of epinephrine auto-injectors was identified as the strongest independent predictor of correct dose knowledge (adjusted odds ratio [aOR] 4.28; 95% CI 1.94-9.46; p<0.001). Professional experience significantly predicted knowledge of intramuscular administration (aOR 1.07; p=0.008).
Conclusion: Although overall knowledge of anaphylaxis among audiologists was moderate, only 50.8% identified epinephrine as first-line treatment, 34.4% knew the intramuscular route, and 42.9% knew the correct dose. Awareness of auto-injectors was strongly associated with correct dose knowledge (aOR 4.28). These findings highlight critical gaps in life-saving knowledge and the need for targeted training programs.

Keywords

Anaphylaxis , audiologists , epinephrine , epinephrine auto-injector , emergency management , health professional education

Ethical Statement

This study was approved by the Institutional Clinical Research Ethics Committee of Malatya Turgut Özal University (Approval No: 2026-32) and conducted in accordance with the Declaration of Helsinki.

Supporting Institution

The authors declare that this study received no financial support.

Thanks

The authors thank all audiologists who voluntarily participated in the national survey.

References

• Cardona V, Ansotegui IJ, Ebisawa M, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13(10):100472. doi:10.1016/j.waojou.2020.100472
• Muraro A, Worm M, Alviani C, et al. EAACI guidelines: anaphylaxis (2021 update). Allergy. 2022;77(2):357-377. doi:10.1111/all.15032
• Resuscitation Council UK. Emergency treatment of anaphylaxis: guidelines for healthcare providers. London: RCUK; 2021.
• Golden DBK, Motosue MS, et al. Anaphylaxis: a practice parameter update. Ann Allergy Asthma Immunol. 2024;132(2):124-176. doi:10.1016/ j.anai.2023.09.015
• Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and GRADE analysis. J Allergy Clin Immunol. 2020;145(4):1082-1123. doi:10.1016/j.jaci.2020.01.017
• Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report-Second NIAID/FAAN symposium. J Allergy Clin Immunol. 2006; 117(2):391-397. doi:10.1016/j.jaci.2005.12.1303
• Brown JC, Simons E, Rudders SA. Epinephrine in the management of anaphylaxis. J Allergy Clin Immunol Pract. 2020;8(4):1186-1195. doi:10. 1016/j.jaip.2019.12.015
• Dodd A, Hughes A, Sargant N, Whyte AF, Soar J, Turner PJ. Evidence update for the treatment of anaphylaxis. Resuscitation. 2021;163:86-96. doi:10.1016/j.resuscitation.2021.04.010
• Australasian Society of Clinical Immunology and Allergy (ASCIA). Guidelines-acute management of anaphylaxis. ASCIA; 2023.
• Turner PJ, Gowland MH, Sharma V, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: UK national anaphylaxis data, 1992-2012. J Allergy Clin Immunol. 2015;135(4):956-963. doi:10.1016/j.jaci.2014.10.021
• Baseggio Conrado A, Ierodiakonou D, Gowland MH, Boyle RJ, Turner PJ. Food anaphylaxis in the United Kingdom: analysis of national data, 1998-2018. BMJ. 2021;372:n251. doi:10.1136/bmj.n251
• Whyte AF, Soar J, Dodd A, Hughes A, Sargant N, Turner PJ. Emergency treatment of anaphylaxis: concise clinical guidance. Clin Med (Lond). 2022;22(4):332-339. doi:10.7861/clinmed.2022-0073
• Leung ASY, Tham EH, Pacharn P, et al. Disparities in pediatric anaphylaxis triggers and management across Asia. Allergy. 2024;79(5):1317-1328. doi:10.1111/all.16098
• Grabenhenrich LB, Dölle S, Moneret-Vautrin A, et al. Anaphylaxis in children and adolescents: the European Anaphylaxis Registry. J Allergy Clin Immunol. 2016;137(4):1128-1137.e1. doi:10.1016/j.jaci.2015.11.015
• Ring J, Beyer K, Biedermann T, et al. Guideline (S2k) on acute therapy and management of anaphylaxis: 2021 update. Allergo J Int. 2021;30(1):1-25. doi:10.1007/s40629-020-00158-y
• Sim M, Sharma V, Li K, et al. Adrenaline auto-injectors for preventing fatal anaphylaxis. Clin Exp Allergy. 2025;55(1):19-35. doi:10.1111/cea.14565
• El Turki A, Smith H, Llewellyn C, Jones CJ. A systematic review of patients’, parents’, and healthcare professionals’ adrenaline auto-injector administration techniques. Emerg Med J. 2017;34(6):403-416. doi:10.1136/emermed-2016-205742
• Antolín-Amérigo D, Vidal-Albareda C, González de Olano D, de la Hoz-Caballer B. Current update on anaphylaxis: anaphylaxis management in recent guidelines. Eur Ann Allergy Clin Immunol. 2024;56(2):51-64. doi: 10.23822/EurAnnACI.1764-1489.306
• Arga M, Topal E, Yılmaz S, Erdemli PC, Bıçakcı K, Bakırtaş A. Healthcare workers’ knowledge level regarding anaphylaxis and usage of epinephrine auto-injectors. Turk J Pediatr. 2021;63(3):372-383. doi:10. 24953/turkjped.2021.03.004
• Narchi H, Elghoudi A, Al Dhaheri K. Barriers and challenges affecting parents' use of adrenaline auto-injector in children with anaphylaxis. World J Clin Pediatr. 2022;11(2):151-159. doi:10.5409/wjcp.v11.i2.151
• Perot A, Ancion A, Paquay M, Ghuysen A. Management of anaphylaxis in the emergency department: applying recommendations for good clinical practice. Rev Med Liege. 2025;80(5-6):339-347.
• Ehrhard S, Gautschi D, Eyb V, et al. Use of epinephrine in anaphylaxis: a retrospective cohort study at a Swiss university emergency department. Swiss Med Wkly. 2023;153:40065. doi:10.57187/smw.2023.40065
• Resuscitation Council UK. Anaphylaxis: IM adrenaline injection site (anterolateral thigh)-clinical guidance. 2021.
• World Allergy Organization. Anaphylaxis: diagnosis and treatment (clinical tool). WAO; 2020.
• Australasian Society of Clinical Immunology and Allergy (ASCIA). Anaphylaxis action plans & acute management resources. ASCIA; 2021.
• Bernstein DI, Blaiss M, Dellon ES, Rance K. Benefits of epinephrine for anaphylaxis outweigh potential harm-a safety review. J Allergy Clin Immunol Pract. 2025;13(12):3188-3194. doi:10.1016/j.jaip.2025.04.018
• Turner PJ, Campbell DE, Motosue MS, Campbell RL. Global trends in anaphylaxis epidemiology and clinical implications. J Allergy Clin Immunol Pract. 2020;8(4):1169-1176. doi:10.1016/j.jaip.2019.11.027
• Simons FE, Ardusso LRF, Bilò MB, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014;7(1):9. doi:10.1186/ 1939-4551-7-9
• Tanimoto S, Kaliner M, Ellis AK, Lowenthal R. Comparison of the pharmacokinetics between intramuscular and subcutaneous manual epinephrine administration. Ann Allergy Asthma Immunol. 2023;130(4): 515-516. doi:10.1016/j.anai.2022.12.010
• Kemp SF, Lockey RF, Simons FER. Epinephrine: the drug of choice for anaphylaxis-A WAO statement. World Allergy Organ J. 2008;1(Suppl 7): S18-S26. doi:10.1097/WOX.0b013e31817c9338
• Bekis Bozkurt H, Pençe İ. Evaluating the use of nasal epinephrine in anaphylaxis: current status. Turk Arch Pediatr. 2025;60(6):572-576. doi: 10.5152/TurkArchPediatr.2025.25050
• Crescioli G, Giovannini M, Pessina B, Barni S, Muraro A, Vannacci A, Mori F. Epinephrine nasal spray for the treatment of anaphylaxis: perspectives in pediatrics. Curr Opin Allergy Clin Immunol. 2025;25(6): 511-517. doi:10.1097/ACI.0000000000001109
• Muraro A, Roberts G, Worm M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014; 69(8):1026-1045. doi:10.1111/all.12437
• Alataş ET, Alataş ÖD, Acar E. Epinephrine auto-injector use on YouTube: is it really useful? Eurasian J Emerg Med. 2019;18(2):68-71. doi: 10.4274/eajem.galenos.2017.36035