Epinephrine autoinjector prescription in food-allergic adults: symptom-based only or allergen-based also? An Italian multi-centre study.
BACKGROUND
Epinephrine is the treatment of choice for acute food-allergic reactions but existing guidelines state that it should be prescribed uniquely to patients who already experienced at least one food-induced anaphylactic episode.


OBJECTIVE
We investigated whether in Italy epinephrine auto-injector is prescribed uniquely following the existing guidelines only, or is allergen-informed as well (i.e., based on the potential risk associated with sensitization to certain food allergens), and hence preventive.


METHODS
1110 adult patients (mean age 31 years; M/F 391/719) with food allergy seen at 19 allergy outpatient clinics were studied. Patients with a history of probable anaphylaxis were identified. Subjects were classified as having primary (type 1) and/or secondary (type 2) food allergy and were divided into several subgroups based on the offending allergen/food. Epinephrine prescriptions were recorded and analyzed both as a whole and by sensitizing allergen.


RESULTS
Epinephrine was prescribed to 138/1100 (13%) patients with a significant difference between subjects with type-1 and type-2 food allergy (132/522 [25%] vs. 6/629 [1%]; p < 0.001). The epinephrine group included most patients with a history of anaphylaxis (55/62 [89%]) or emergency department visits 106/138 (77%). In some specific subsets, namely fish-, tree nuts-, and lipid trasfer protein (LTP)-allergic patients, epinephrine was prescribed to patients without a history of systemic allergic reactions.


CONCLUSIONS
Italian allergy specialists prescribe epinephrine auto-injectors both on the basis of clinical history of severe reactions and on a critical analysis of the hazard associated with the relevant protein allergens, which suggests a good knowledge of allergens as well as acquaintance with the guidelines for prescription of emergency medication.
Asero
R
R
Clinica San Carlo, Paderno Dugnano, MI, Italy.
Antonicelli
L
L
Arena
A
A
Bommarito
L
L
Caruso
B
B
Colombo
G
G
Crivellaro
M
M
De Carli
M
M
Della Torre
E
E
Della Torre
F
F
Heffler
E
E
Lodi Rizzini
F
F
Longo
R
R
Manzotti
G
G
Marcotulli
M
M
Melchiorre
A
A
Minale
P
P
Morandi
P
P
Moreni
B
B
Moschella
A
A
Murzilli
F
F
Nebiolo
F
F
Poppa
M
M
Randazzos
S
S
Rossi
G
G
Senna
G E
GE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology*; D000707:Anaphylaxis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D002648:Child; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005512:Food Hypersensitivity / Q000150:complications / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D055656:Prescriptions; D012646:Self Administration
D000485:Allergens; D004837:Epinephrine