Asero R, Antonicelli L, Arena A, Bommarito L, Caruso B, Colombo G, Crivellaro M, De Carli M, Della Torre E, Della Torre F, Heffler E, Lodi Rizzini F, Longo R, Manzotti G, Marcotulli M, Melchiorre A, Minale P, Morandi P, Moreni B, Moschella A, Murzilli F, Nebiolo F, Poppa M, Randazzos S, Rossi G, Senna G E
Clinica San Carlo, Paderno Dugnano, MI, Italy.
Eur Ann Allergy Clin Immunol. 2010 Feb;42(1):25-31.
Epinephrine is the treatment of choice for acute food-allergic reactions but existing guidelines state that it should be prescribed uniquely to patients who already experienced at least one food-induced anaphylactic episode.
We investigated whether in Italy epinephrine auto-injector is prescribed uniquely following the existing guidelines only, or is allergen-informed as well (i.e., based on the potential risk associated with sensitization to certain food allergens), and hence preventive.
1110 adult patients (mean age 31 years; M/F 391/719) with food allergy seen at 19 allergy outpatient clinics were studied. Patients with a history of probable anaphylaxis were identified. Subjects were classified as having primary (type 1) and/or secondary (type 2) food allergy and were divided into several subgroups based on the offending allergen/food. Epinephrine prescriptions were recorded and analyzed both as a whole and by sensitizing allergen.
Epinephrine was prescribed to 138/1100 (13%) patients with a significant difference between subjects with type-1 and type-2 food allergy (132/522 [25%] vs. 6/629 [1%]; p < 0.001). The epinephrine group included most patients with a history of anaphylaxis (55/62 [89%]) or emergency department visits 106/138 (77%). In some specific subsets, namely fish-, tree nuts-, and lipid trasfer protein (LTP)-allergic patients, epinephrine was prescribed to patients without a history of systemic allergic reactions.
Italian allergy specialists prescribe epinephrine auto-injectors both on the basis of clinical history of severe reactions and on a critical analysis of the hazard associated with the relevant protein allergens, which suggests a good knowledge of allergens as well as acquaintance with the guidelines for prescription of emergency medication.
肾上腺素是急性食物过敏反应的首选治疗药物，但现有指南规定，肾上腺素仅应开给已经经历过至少一次食物诱发过敏反应的患者。
我们调查了在意大利，肾上腺素自动注射器是否仅按照现有指南开具，还是也会考虑过敏原信息（即基于对某些食物过敏原致敏相关的潜在风险），从而具有预防性。
对在19个过敏门诊就诊的1110名成年食物过敏患者（平均年龄31岁；男/女391/719）进行了研究。确定有疑似过敏反应病史的患者。受试者被分类为患有原发性（1型）和/或继发性（2型）食物过敏，并根据致病过敏原/食物分为几个亚组。记录并分析肾上腺素处方，整体分析以及按致敏过敏原分析。
1100名患者中有138名（13%）开具了肾上腺素，1型和2型食物过敏患者之间存在显著差异（132/522 [25%] 对6/629 [1%]；p < 0.001）。肾上腺素组包括大多数有过敏反应病史的患者（55/62 [89%]）或去过急诊科的患者106/138（77%）。在一些特定亚组中，即对鱼、坚果和脂质转移蛋白（LTP）过敏的患者中，没有全身过敏反应病史的患者也开具了肾上腺素。
意大利过敏专科医生根据严重反应的临床病史以及对相关蛋白质过敏原相关危害的批判性分析来开具肾上腺素自动注射器，这表明他们对过敏原的了解以及对急救药物处方指南的熟悉程度良好。
