Epinephrine Prescribing Patterns Among Allergists

Epinephrine can be used in the event of possibly fatal allergic reactions, but current prescription trends among allergists have not been previously reported. A recent study analyzed trends in prescribing and usage patterns among allergists, and the results were published as part of the AAAAI Annual Meeting.

A 20% sample of AAAAI members and the entire American College of Allergy, Asthma, and Immunology (ACAAI) membership received an electronic, 19-item survey regarding prescribing and treatment scenarios and trends. A total of 648 allergists responded. Most (97.0%) said they regularly prescribe epinephrine auto-injectors (EAIs), while about three in five (61.4%) regularly provide emergency action plans (EAP). The most common indication for EAI prescribing was for idiopathic anaphylaxis, followed by 84.4% for venom immunotherapy, 70.1% for food allergy patients, 49.4% for biologics, and 29.4% for inhalant immunotherapy.

When asked about EAPs, just more than half of respondents (54.9%) said they always/sometimes use the American Academy of Pediatrics version; one-third use the Food Allergy Research & Education version, 23.7% the ACAAI version, and 17.0% the AAAAI version. Nearly three in five allergists (58.0%) said that antihistamines have no or a very limited role; 8.9% and 7.8% said they advise or use epinephrine for any home or in-office reaction, respectively.

More allergists reported recommending epinephrine for a venom trigger (20.5%) than a food trigger (13.8%) in patients with only mild symptoms. Nearly seven in 10 allergists (69.0%) recommend their patients carry more than two EAIs, and about half (50.2%) recommend preemptive EAIs to treat allergen exposure prior to the first sign of symptoms. An association was observed between time in practice and lower odds of EAI prescription for immunotherapy, but time in practice was not correlated with providing EAP, advising preemptive use, or the role of antihistamines.

“Epinephrine is more routinely prescribed for venom allergy and idiopathic anaphylaxis than food allergy,” the authors concluded. “There are wide variations in practice, with 58% believing antihistamines have no or limited role in treating allergic reactions.”

https://www.jacionline.org/article/S0091-6749(19)32554-0/fulltext