title: Epinephrine autoinjector prescription in food-allergic adults: symptom-based only or allergen-based also? An Italian multi-centre study.
abstract: 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.
authors.affiliation: Clinica San Carlo, Paderno Dugnano, MI, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Asero
authors.forename: L
authors.initials: L
authors.lastname: Antonicelli
authors.forename: A
authors.initials: A
authors.lastname: Arena
authors.forename: L
authors.initials: L
authors.lastname: Bommarito
authors.forename: B
authors.initials: B
authors.lastname: Caruso
authors.forename: G
authors.initials: G
authors.lastname: Colombo
authors.forename: M
authors.initials: M
authors.lastname: Crivellaro
authors.forename: M
authors.initials: M
authors.lastname: De Carli
authors.forename: E
authors.initials: E
authors.lastname: Della Torre
authors.forename: F
authors.initials: F
authors.lastname: Della Torre
authors.forename: E
authors.initials: E
authors.lastname: Heffler
authors.forename: F
authors.initials: F
authors.lastname: Lodi Rizzini
authors.forename: R
authors.initials: R
authors.lastname: Longo
authors.forename: G
authors.initials: G
authors.lastname: Manzotti
authors.forename: M
authors.initials: M
authors.lastname: Marcotulli
authors.forename: A
authors.initials: A
authors.lastname: Melchiorre
authors.forename: P
authors.initials: P
authors.lastname: Minale
authors.forename: P
authors.initials: P
authors.lastname: Morandi
authors.forename: B
authors.initials: B
authors.lastname: Moreni
authors.forename: A
authors.initials: A
authors.lastname: Moschella
authors.forename: F
authors.initials: F
authors.lastname: Murzilli
authors.forename: F
authors.initials: F
authors.lastname: Nebiolo
authors.forename: M
authors.initials: M
authors.lastname: Poppa
authors.forename: S
authors.initials: S
authors.lastname: Randazzos
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: G E
authors.initials: GE
authors.lastname: Senna
mesh_terms: 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
chemical_list: D000485:Allergens; D004837:Epinephrine