Trends and determinants of epinephrine prescriptions: a proxy of anaphylaxis epidemiology?

Costa, Enrico; Tanno, Luciana Kase; Salazzari, Damiano; Tedeschi, Federico; Andretta, Margherita; Caminati, Marco

doi:10.1097/aci.0000000000000861

Cited by 3 publications

(1 citation statement)

References 45 publications

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“…1 Low AAI prescription and refill rates have been recorded even in the absence of significant socio-economic barriers, suggesting that economical limitations only partially account for the issue and cultural restrictions should also be considered. 32 All these reflects the need for continued advocacy for the optimal management of foodinduced anaphylaxis and implementation of educational strategies regarding universal preventive measures (avoidance strategies, intervention drugs) and the primacy of adrenaline and the not primacy of GCS in treating anaphylaxis in children. 33,34…”

Section: Pharmacological Interventions and Preventive Measuresmentioning

confidence: 99%

Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

Cichocka‐Jarosz

Dölle‐Bierke

Jedynak-Wąsowicz

et al. 2023

Clinical & Translational All

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Background Cow's milk (CM) and hen's egg (HE) are leading triggers of anaphylaxis in early childhood. The aim of this study was to identify clinical phenotypes and therapeutic measures for CM anaphylaxis (CMA) compared to HE anaphylaxis (HEA) in children up to 12 years of age, based on a large pan‐European dataset from the European Anaphylaxis Registry. Methods Data from 2007 to 2020 on clinical phenotypes and treatment from 10 European countries, as well as Brazil, were analysed. The two‐step cluster analysis was used to identify the most frequent phenotypes. For each trigger, three clusters were extracted based on sex, age, and existence of symptoms in four vitally important systems. Results Altogether 284 children with CMA and 200 children with HEA were identified. They were characterised as male (69% vs. 64%), infants (65% vs. 61%), with a most frequent grade III of Ring&Messmer classification (62% vs. 64%), in CMA versus HEA, respectively. Respiratory symptoms occurred more often in CMA (91% vs. 83%, p = 0.010), especially in infants (89% vs. 79%, p = 0.008). Cardiovascular symptoms were less frequent in CMA (30% vs. 44%, p = 0.002), in both infants (33% vs. 46%, p = 0.027), and older children (25% vs. 42%, p = 0.021). The clusters extracted in the CMA group were characterised as: (1) mild dermal infants with severe GI (40%), 2. severe dermal (35%), 3. respiratory (25%). While in HEA group: 1. infants with severe GI and/or reduction of alertness (40%), (2) conjunctival (16%), (3) mild GI without conjunctivitis (44%). The severity of the reaction was independent from the amount of ingested allergen protein, regardless of trigger. The first‐line adrenaline application differed between the countries (0%–92%, as well as the reasons for not administering adrenaline, p < 0.001). Conclusions Despite the similarity of their age, sex, and severity grade, the clinical profiles differed between the CMA and HEA children. Adrenaline was underused, and its administration was country dependent. Further studies are needed to assess to what extent the differences in the clinical profiles are related to matrix and/or absorption effects, and/or the allergen itself.

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Section: Pharmacological Interventions and Preventive Measuresmentioning

confidence: 99%

Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

Cichocka‐Jarosz

Dölle‐Bierke

Jedynak-Wąsowicz

et al. 2023

Clinical & Translational All

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Anaphylaxis: glimpse into the future, attention to the present

Olivieri,

Senna,

Castells

2024

Current Opinion in Allergy &Amp; Clinical Immunology

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Changes in epinephrine dispensings and allergy hospitalisations in Sweden in the years following the removal of autoinjector co-payments

Ahlstedt,

Bergström,

Nilsson

et al. 2024

Front. Allergy

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IntroductionTo understand any possible healthcare system benefits and changes of behavior for the patients with the change in prescription co-payment in Sweden we aimed to provide an update on the trends of EAI dispensings and hospitalizations for the Swedish paediatric population (ages 0–19 years), from 2018 to 2022, including by sex and geographic region.MethodsUsing publically-available, population-level aggregate data from Sweden's National Board of Health and Welfare, we extracted information on annual epinephrine (ATC C01CA24) dispensings per 1,000 inhabitants from 2018 to 2023, overall, as well as stratified by sex, age groups and geographic region; and on inpatient stays 2018–2022 (ICD-10 code T78), anaphylaxis and other allergic reactions, per 100,000 individuals. We compared these estimates to those for adults ages 18 + years, for whom prescription co-payments remained in place.ResultsEAI dispensings remained stable for children and adults across the study period, with the exception of statistically significant decreases amongst dispensings for children across all ages in 2021 (6.65/1,000) and 2022 (7.37/1,000), compared to 2018 (8.63/1,000) (each year p = 0.03 compared to 2018 dispensings). National EAI dispensings did not statistically significantly differ from 2018 (8.63/1,000) to 2023 (6.70/1,000) amongst children. EAI dispensings for children ages 5 + years consistently exceed dispensings for adults per 1,000 inhabitants; only children aged 0–4 years had proportionately fewer dispensings. Children ages 0–4 years tended to be hospitalised more often than older children, albeit these differences were not statistically significant (all p > 0.97).ConclusionSubsequent to the removal of out-of-pocket costs for EAI, dispensings did not increase for children, although more EAI were dispensed to children from age 5 years, compared to younger children. Allergy-related hospitalisations were highest amongst children ages 0–4, lower amongst children ages 5–14 years, and again higher amongst those ages 15–19 years.

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Trends and determinants of epinephrine prescriptions: a proxy of anaphylaxis epidemiology?

Cited by 3 publications

References 45 publications

Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

Anaphylaxis: glimpse into the future, attention to the present

Changes in epinephrine dispensings and allergy hospitalisations in Sweden in the years following the removal of autoinjector co-payments

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