Should Epinephrine Autoinjectors Be Prescribed to All Patients on Subcutaneous Immunotherapy?

Subcutaneous allergen immunotherapy (SCIT) clearly benefits appropriately selected patients with allergic rhinitis, asthma and anaphylaxis to stinging insects. Since inception of SCIT, systemic allergic reactions (SRs) and severe anaphylaxis have been risk management challenges facing the practicing allergist. Recently it has estimated that 14% of reported SRs begin at least 30 minutes after injection administration or after the 30 minute recommended clinic observation period. Faced with the possibility that SRs could occur after the patient leaves the clinic, some practicing allergists routinely prescribe epinephrine auto-injectors to all injection patients. This article summarizes the key arguments for and against routine prescription of epinephrine auto-injectors for all allergen injection patients, discussed in a PRO/CON debate at the 2015 AAAAI meeting. Currently, there is insufficient clinical evidence to make a strong recommendation for or against this practice.