# Detecting epinephrine auto-injector shortages in Finland 2016–2022: Log-data analysis of online information seeking

## TL;DR

This study analyzed online search patterns in Finland to detect shortages of epinephrine auto-injectors used for treating severe allergic reactions.

## Contribution

The study demonstrates how online log data from professional and public health databases can signal epinephrine shortages and seasonal anaphylaxis trends.

## Key findings

- Professionals' searches for EpiPen® correlated with global shortages, showing seasonal patterns and a peak during the 2018 shortage.
- Citizens' article openings about anaphylaxis increased during summer and at the start of the COVID-19 vaccination period, when prescriptions were lowest.

## Abstract

Medicine shortages prevail as a worldwide problem causing life-threatening situations for adults and children. Epinephrine auto-injectors are used for serious allergic reactions called anaphylaxis, and alternative auto-injectors are not always available in pharmacies. Healthcare professionals in Finland use the dedicated internet source, Physician’s Database (PD), when seeking medical information in practice, while Health Library (HL) provides health information for citizens (S1 Data). The objectives were to assess whether (1) professionals’ searches for epinephrine auto-injectors and (2) citizens’ anaphylaxis article openings relate to epinephrine shortages in Finland.

Monthly log data on epinephrine auto-injectors (EpiPen®, Jext®, Emerade®) from PD and on openings of anaphylaxis articles from HL were collected during 2016–2022. Professionals’ searches of seven auto-injectors and citizens’ openings of four anaphylaxis articles were compared to information on epinephrine shortages reported by Finnish Medicines Agency. Professionals’ auto-injector prescriptions provided by Social Insurance Institution were also assessed.

Total searches in EpiPen® (N = 111,740), Jext® (N = 25,631), and Emerade® (N = 18,329) could be analyzed during 2016–2022. EpiPen® only could visually show seasonal patterns during summertime, peaking vigorously in the summer of 2018 when the major EpiPen® shortage appeared worldwide. Anaphylaxis articles equaled 2,030,855 openings altogether. Openings of one anaphylaxis article (“Bites and Stings”) peaked during summertime, while another article (“Anaphylactic Reaction”) peaked only once (three-fold increase) at the end of 2020 when COVID-19 vaccinations started, and auto-injector prescriptions were lowest. Fifty EpiPen®, one Jext®, and twelve Emerade® shortages were reported. Almost a two-fold increase in peaks of auto-injector prescriptions was found during summertime.

This study shows that (1) epinephrine shortages related to professionals’ searching for auto-injectors, and (2) citizens’ information seeking on anaphylaxis related to summertime and shortages with lesser prescriptions. Therefore, the dedicated internet databases aimed at professionals and citizens could be used as additional information sources to detect anaphylactic reactions and auto-injector shortages.