EAACI Task force Clinical epidemiology of anaphylaxis: experts' perspective on the use of adrenaline autoinjectors in Europe

Magdalena Kraft; Sabine Dölle-Bierke; Paul J Turner; Antonella Muraro; Montserrat Fernández-Rivas; Linus Grabenhenrich; Margitta Worm

doi:10.1186/s13601-020-00317-y

EAACI Task force Clinical epidemiology of anaphylaxis: experts' perspective on the use of adrenaline autoinjectors in Europe

Clin Transl Allergy. 2020 May 11:10:12. doi: 10.1186/s13601-020-00317-y. eCollection 2020.

Authors

Magdalena Kraft¹, Sabine Dölle-Bierke¹, Paul J Turner², Antonella Muraro³, Montserrat Fernández-Rivas⁴, Linus Grabenhenrich^{1

5}, Margitta Worm¹

Affiliations

¹ 1Division of Allergy and Immunology, Dpt. of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
² 2Section of Inflammation, Repair & Development, National Heart & Lung Institute, Imperial College London, London, UK.
³ 3Food Allergy Referral Centre, Department of Women and Child Health, Padua General University Hospital, Padua, Italy.
⁴ 4Department of Allergy, Hospital Clinico San Carlos, Universidad Complutense, IdISSC, ARADyAL, Madrid, Spain.
⁵ 5Department for Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany.

Abstract

Background: Worldwide, guidelines recommend the use of adrenaline autoinjectors (AAIs) for self-medication in patients who experience severe allergic reaction. The European Medical Agency recommends the prescription of two AAIs, which should be carried by patients at all times. The European Academy of Allergy and Clinical Immunology guidelines propose to prescribe a second AAI under some defined conditions. In the present study, we aimed to examine the adherence to these guidelines and prescription behavior of allergy experts regarding the number of AAIs prescribed for a given patient.

Methods: A standardized questionnaire was applied to the participants of the 5th International Conference of the Network of Online Registration for Anaphylaxis (NORA e. V.). Twenty-six experts (medical doctors with at least 2 years of experience in the field of anaphylaxis) answered the questions regarding the number of autoinjectors prescribed and the reasons influencing their decisions.

Results: Sixty-eight percent of the experts usually prescribed one AAI, while 32% prescribed two. The pediatricians and physicians with less experience tended to prescribe two autoinjectors more frequently. The experts were more likely to prescribe two adrenaline autoinjectors if the patient was a child, had a previous severe reaction, had mastocytosis, asthma, cardiovascular disease, or high body weight, or lived far from the emergency department.

Conclusion: Our data confirm the lack of consensus regarding the number of AAIs to prescribe. Despite the European Medical Agency recommendation, the majority of allergy experts prescribed one autoinjector per patient. However, under distinct circumstances (e.g. mastocytosis, asthma, excess body weight, a history of severe anaphylaxis, or restricted access to immediate emergency), experts tended to prescribe more AAIs, which is in accordance with the European Academy of Allergy and Clinical Immunology guidelines.

Keywords: AAI; Adrenaline autoinjector; Anaphylactic reaction; Anaphylaxis; Epinephrine autoinjector; European Academy of Allergy and Clinical Immunology guidelines; European Medical Agency.