Use of Epinephrine Autoinjectors in patient with Hymenoptera venom allergy and food anaphylaxis among 8 italian Gps

Francesco Del Zotti, Claudia Negri, Giulio Rigon, Gianenrico Senna

Keywords: anaphylaxis; urgency; empowerment

Anaphylactic crisis caused by an allergy to hymenoptera venom or foods is hard to prevent, but can be treated by the patient, if he is equipped with certain drugs and in particular the epinephrine autoinjectors with specific training.

Research questions:
A) Evaluate the prevalence of food-related and hymenoptera venom anaphylaxis in patients
B) Evaluate the frequency of request for appropriate tests and drugs; and the prescription of epinephrine and the corresponding training for the use of the autoinjector.

8 GPs from the italian Netaudit group ( extracted ECRs with icd9 codes of anaphylactic shock by hymenoptera venom and food allergies from their records.
For the patients extracted we evaluated whether the diagnosis corresponded to the criteria of a Consensus article and checked presence of the tests, drugs and prescriptions of epinephrine, according the guidelines.

8 GPs participated with a total of 11162 in office.
21 Patients / 11162 (prevalence 0.19%) are positive for the chosen criteria; 6 females and 15 males, with variability in the number of cases per GP (minimum 1; maximum 7; median: 2).
Of these 21 cases: 10 have food allergies; 8 to the hymenoptera venom; 3 to both
The allergology consultation was requested in 16 out of 21 cases; The tryptase test (useful for excluding mastocytosis in allergies to hymenoptera) in 3 cases
Corticosteroid and antihistamines were administered in the majority of cases.
The prescription of epinephrine autoinjector is present in 7 of 21 cases. The information-education (intra-hospital or from the GP) on the use of autoinjector was present in 7 of the 21 ECR

The prevalence of findings seems lower than that of the literature. There is a great work for improvement both in the variability of the recording of cases in the record, and in the role of Gp’s management for the avoidable consequences of anaphylaxis

Points for discussion:
a) How much coding system different from the ICD9 can help in the classification of these anaphylaxis?

b) How does the reimbursement of fast adrenaline vary in the European Countries?

c) How to improve collaboration between GPs, emergency rooms and allergologists?