Epinephrine autoinjector prescription in food-allergic adults: symptom-based only or allergen-based also? An Italian multi-centre study

Eur Ann Allergy Clin Immunol. 2010 Feb;42(1):25-31.


Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Allergens / immunology*
  • Anaphylaxis / complications
  • Anaphylaxis / drug therapy*
  • Anaphylaxis / immunology*
  • Anaphylaxis / physiopathology
  • Child
  • Epinephrine / administration & dosage
  • Epinephrine / therapeutic use*
  • Food Hypersensitivity / complications
  • Food Hypersensitivity / drug therapy*
  • Food Hypersensitivity / immunology*
  • Food Hypersensitivity / physiopathology
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Prescriptions
  • Self Administration


  • Allergens
  • Epinephrine