National guidelines recommend that patients with anaphylaxis be prescribed an epinephrine auto-injector (i.e. EpiPen) and referred to an allergy specialist. In this study we look at what percentage of patients are given epinephrine injectors and referred to see an allergy doctor upon discharge from the emergency room after an anaphylaxis episode.
Anaphylaxis is a life threatening systemic allergic reaction associated with a risk of recurrence. Past studies have shown that 1 in 12 patients with a history of anaphylaxis will have a subsequent episode. Previous studies have shown that post-emergency guideline recommendations are not routinely followed. Having an epinephrine auto-injector and a follow up with an allergy specialist are key tools to prevent and manage subsequent anaphylaxis episodes. An allergist can provide an opportunity to identify triggers and provide anaphylaxis education including strategies to avoid triggers and what to do in case of a severe allergic reaction. Patients can also be considered for additional treatment besides avoidance. Venom allergic patients can be referred for desensitization. Prevention of future anaphylaxis is key and can limit the future financial burden of allergies. Previous studies have shown that the total economic burden of food allergy and anaphylaxis alone in the United States is half a billion dollars. Beyond the cost, epinephrine dispensing and allergy follow up care can relieve potential patient stress and anxiety. Approximately 40% of parents reported that food allergy had a significant impact on their overall stress levels and affected their family social gatherings.
A recent study published in the Annals of Allergy, Asthma and Immunology identified approximately 8,000 patients discharged from an emergency after an anaphylaxis episode, 46.5% had an epinephrine auto-injector dispensed and 28.8% had Allergy/Immunology follow up within 1 year after discharge.
These low rates of epinephrine prescribing and referrals to see an allergist are nowhere near what is recommended by national and international guidelines after anaphylaxis. If you or a family/friend member have had an episode of anaphylaxis, speak to your doctor about getting an epinephrine auto-injector prescription and see an allergy specialist after to help prevent future reactions.