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Sandra Salter

Phone: (+61 4) 1600 3808
Fax: (+61 8) 9389 7628

Start date

Nov 2011

Submission date

Nov 2014

Curriculum vitae

Sandra Salter CV
[text/rtf, 64.01 kb]
Updated 03 Sep 2014

Sandra Salter

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Investigating the management of anaphylaxis in pharmacy: a growing need for pharmacist-driven community competence in the preparedness and care of patients at risk of anaphylaxis.


Anaphylaxis is a rapid-onset, life threatening, severe allergic reaction. It is commonly triggered by foods, stinging insects, medicines, exercise and other allergens. Anaphylaxis may occur anywhere, and it is in the community where it is of most concern: access to a health professional may be limited, and anaphylaxis may rapidly progress to death.

Self-injectable adrenaline is frequently prescribed to anaphylaxis patients, to enable rapid first aid before medical attention is sought. In Australia adrenaline (as EpiPen and Anapen devices) is supplied by pharmacists with or without a doctor’s prescription. Devices supplied on prescription are subsidised through the Medicare Australia Pharmaceutical Benefits Scheme (PBS). Before the listing of Anapen in 2010, EpiPen was the sole device available in Australia. A new-look EpiPen became available in 2011, and for a period all three devices were sold. In 2003, funding for self-injectable epinephrine from Medicare Australia totalled AU$188,000. In 2013, this had risen to nearly AU$13 million; almost a 70-fold increase. Pharmacists in community pharmacies supplied all of these devices to patients, yet we do not know how (or if) they advise patients about anaphylaxis. Furthermore, some patients seek immediate treatment from their pharmacist for acute anaphylaxis, yet we do not know if pharmacists are prepared to handle these emergencies.

The purpose of this research of Australian community pharmacists was to:

1. Measure pharmacist knowledge about anaphylaxis and the long term impact of anaphylaxis training on knowledge;

2. Identify (under real-world conditions) pharmacist preparedness for acute anaphylaxis (and factors that impact on such preparedness)

3. Measure (under real-world conditions) pharmacist accuracy in demonstrating EpiPen and Anapen devices, and identify factors that impact on accurate demonstration.

4. Develop the role of the pharmacist in managing anaphylaxis, as part of urgent community care.

Why my research is important

Given the unpredictable nature of anaphylaxis, the dramatic rise in food-induced anaphylaxis, the potential for first-time reactions to be fatal, and the accessibility of pharmacists as a treatment destination, there is an urgent need to identify if pharmacists are ready to manage anaphylaxis. An importantly duality in anaphylaxis management must be considered – firstly providing first aid when required, and secondly engaging the non-acute patient in discussion so they may be prepared for future events. To be able to do this, pharmacists must have the requisite knowledge of anaphylaxis and its management. In 2011, the Australasian Society of Clinical Immunology and Allergy (ASCIA) launched ASCIA Anaphylaxis e-training for Pharmacists to accommodate the need for accurate, consistent anaphylaxis education for pharmacists. The importance of ensuring this training is effective at increasing anaphylaxis knowledge is paramount to reducing the risk of fatal anaphylaxis in the community. Coupled with improved knowledge is the importance of translation of knowledge to practice. High-level preparedness and accurate device use will save lives in this most severe and frightening of allergic diseases.


  • The University of Western Australia (University Postgraduate Award and UWA Safety Net Top-Up Scholarship) 2011-2014
  • Pharmaceutical Society of Western Australia JM O’Hara Research Grant