Current practices among allergists on writing self-injectable epinephrine prescriptions for immunotherapy patients

Gupta, Payel; Gerrish, Prianka K.; Silverman, Bernard A.; Schneider, Arlene T.

doi:10.1016/j.jaci.2011.09.033

Cited by 10 publications

(4 citation statements)

References 8 publications

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“…Our survey found significant differences in AIE prescription rates in Otolaryngology Allergy physicians compared with previous studies examining AAAAI physicians [30]. We showed a high rate of AIE prescription for both SCIT and SLIT patients.…”

Section: Discussioncontrasting

confidence: 48%

“…Specifically a study by P Gutpa et al queried members of the AAAAI with 299 respondents showing a 33.3% rate of epinephrine prescriptions for all patients on SCIT, 52.7% rate of risk stratification, and 13.5% rate of never prescribing epinephrine for SCIT. They found a large variation in practice pattern in terms of adhering to anaphylaxis action plans, occurrence of systemic reactions after leaving the office, and adherence to observation in clinic for 30 minutes following injection [30]. Similar practice patterns have not been elucidated in the otolaryngologic allergy community.…”

Section: Introductionmentioning

confidence: 99%

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Current Practices in Prescribing Auto-Injectable Epinephrine during Immunotherapy amongst Otolaryngic Allergists

Haroun¹,

Watley²,

Siddiqui³

2021

IJOHNS

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Purpose: Allergen immunotherapy (AIT) while usually safe, is not without risk. Both sublingual (SLIT) and subcutaneous immunotherapy (SCIT) have the potential for systemic reactions including anaphylaxis. Materials and Methods: A short survey was distributed to fellows of the American Academy of Otolaryngic Allergy (AAOA) (n = 553) in July of 2019 to determine current prescribing practices. Results: A total of 103/553 surveys were completed, giving a response rate of 18.6%. Prescribing patterns for SCIT showed 79.6% prescribed auto-injectable epinephrine (AIE) to all patients, 11.7% prescribed only to high risk patients, while 1.9% did not prescribe AIE at all. SLIT showed similar patterns with 71.8% prescribing AIE to all, 11.7% to high risk or letting patient choose, and 6.8% did not prescribe to anyone. Just under half of the physicians responded affirmatively to giving a written anaphylaxis plan to patients on immunotherapy. 48.5% physicians reported treating in-office anaphylaxis due to SCIT or skin testing in the past year, while 6% reported anaphylaxis due to SLIT. Conclusions: A majority of otolaryngic allergists are still prescribing AIE for both SCIT and SLIT. With the recent higher costs attributed to AIE as well as drug shortages, some physicians are risk-stratifying patients. While SCIT has a higher risk for treatment related systemic reactions, anaphylaxis does occur with SLIT, thus making it imperative to counsel patients on a clear anaphylaxis protocol in all forms of AIT.

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Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Current Practices in Prescribing Auto-Injectable Epinephrine during Immunotherapy amongst Otolaryngic Allergists

Haroun¹,

Watley²,

Siddiqui³

2021

IJOHNS

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“…As an example, although many anaphylaxis episodes after allergen SCIT begin after the typical 30-min on-site observation period in the clinic, for patients on SCIT, 13.5% of allergists never prescribe EAIs, 33.3% always prescribe EAIs, and 52.7% risk-stratify [63]. …”

Section: Long-term Management: Self-treatment In Community Settingsmentioning

confidence: 99%

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Simons

Ardusso

Dimov

et al. 2013

Int Arch Allergy Immunol

247

181

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The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis are a widely disseminated and used resource for information about anaphylaxis. They focus on patients at risk, triggers, clinical diagnosis, treatment in health care settings, self-treatment in the community, and prevention of recurrences. Their unique strengths include a global perspective informed by prior research on the global availability of essentials for anaphylaxis assessment and management and a global agenda for anaphylaxis research. Additionally, detailed colored illustrations are linked to key concepts in the text [Simons et al.: J Allergy Clin Immunol 2011;127:593.e1-e22]. The recommendations in the original WAO Anaphylaxis Guidelines for management of anaphylaxis in health care settings and community settings were based on evidence published in peer-reviewed, indexed medical journals to the end of 2010. These recommendations remain unchanged and clinically relevant. An update of the evidence base was published in 2012 [Simons et al.: Curr Opin Allergy Clin Immunol 2012;12:389-399]. In 2012 and early 2013, major advances were reported in the following areas: further characterization of patient phenotypes; development of in vitro tests (for some allergens) that help distinguish clinical risk of anaphylaxis from asymptomatic sensitization; epinephrine (adrenaline) research, including studies of a new epinephrine auto-injector for use in community settings, and randomized controlled trials of immunotherapy to prevent food-induced anaphylaxis. Despite these advances, the need for additional prospective studies, including randomized controlled trials of interventions in anaphylaxis is increasingly apparent. This 2013 Update highlights publications from 2012 and 2013 that further contribute to the evidence base for the recommendations made in the original WAO Anaphylaxis Guidelines. Ideally, it should be used in conjunction with these Guidelines and with the 2012 Guidelines Update.

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“…21 Therefore, many physicians consider it prudent for patients on immunotherapy to carry an epinephrine autoinjector, but there is no consensus. A survey 22 found that 13.5% of allergists did not prescribe the autoinjector for patients on immunotherapy, while 33.3% prescribed it for all their patients on immunotherapy, and the rest prescribed based on risk.…”

Section: Histamine Blockers and Corticosteroids Should Be Second-linementioning

confidence: 99%

Who needs to carry an epinephrine autoinjector?

Song

Lieberman

2019

CCJM

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A naphylaxis is potentially fatal but can be prevented if the trigger is identifi ed and avoided, and death can be avoided if episodes are treated promptly. A consensus defi nition of anaphylaxis has been diffi cult to achieve, with slight variations among international guidelines. The World Allergy Organization classifi es anaphylaxis as immunologic, nonimmunologic, or idiopathic. 1 The National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network highlight clinical symptoms and criteria. 2 The International Consensus on Food Allergy describes reactions as being immunoglobulin E (IgE)-mediated, cell-mediated, or a combination of the 2 mechanisms. 3 Despite the subtle differences in these definitions, all 3 international organizations have a common recommendation for anaphylaxis: once it is diagnosed, epinephrine is the treatment of choice. ■ EPINEPHRINE IS THE TREATMENT OF CHOICE FOR ANAPHYLAXIS Anaphylaxis commonly results from exposure to foods, medications, and Hymenoptera venom. 4 Avoiding triggers is key in preventing anaphylaxis but is not always possible. Although epinephrine is the cornerstone of the emergency treatment of anaphylaxis, many patients instead receive antihistamines and corticosteroids as initial therapy. Some take these medications on their own, and some receive them in emergency departments and outpatient clinics. 5 Diphenhydramine, a histamine 1 receptor antagonist, is often used as a fi rst-line medication. But diphenhydramine has a slow onset of action, taking 80 minutes after an oral dose REVIEW Dr. Song has disclosed membership on advisory committees or review panels for Allergopharma, and teaching and speaking for Novartis and Teva. Dr. Lieberman has disclosed consulting for Kaléo.

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Current practices among allergists on writing self-injectable epinephrine prescriptions for immunotherapy patients

Cited by 10 publications

References 8 publications

Current Practices in Prescribing Auto-Injectable Epinephrine during Immunotherapy amongst Otolaryngic Allergists

Current Practices in Prescribing Auto-Injectable Epinephrine during Immunotherapy amongst Otolaryngic Allergists

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Who needs to carry an epinephrine autoinjector?

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