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Published in: Allergy, Asthma & Clinical Immunology 1/2015

Open Access 01-12-2015 | Research

Epinephrine auto-injector prescriptions to food-allergic patients in primary care in The Netherlands

Authors: Jacquelien Saleh-Langenberg, A. E. J. Dubois, F. Groenhof, J. W. H. Kocks, T. van der Molen, B. M. J. Flokstra-de Blok

Published in: Allergy, Asthma & Clinical Immunology | Issue 1/2015

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Abstract

Background

The knowledge of general practitioner(s) (GPs) regarding food allergy and anaphylaxis and practices in the prescription of epinephrine auto-injector(s) (EAIs) among GPs has previously only been studied using questionnaires and hypothetical cases. Therefore, there are currently no data as to whether or not GPs prescribe EAIs to high risk food-allergic patients presenting to primary care practices. The aim of this study was therefore to describe and evaluate practice in EAI prescription by GPs to food-allergic patients in The Netherlands.

Methods

Patients aged 12–23 years who consulted their GP for allergic symptoms were identified in a primary care database. Patients were classified as probably or unlikely to be food-allergic. A risk factor assessment was done to identify probably food-allergic patients at high risk for anaphylaxis to assess the need for an EAI.

Results

One hundred forty-eight out of 1015 patients consulted their GP for allergic symptoms due to food. Eighty patients were excluded from analysis because of incomplete records. Thirty-four patients were classified as probably food-allergic. Twenty-seven of them were considered high risk patients and candidates for an EAI. Importantly, only 10 of them had actually been prescribed an EAI by their GP.

Conclusions

This study shows that high risk food-allergic patients that visit their GPs are often not prescribed an EAI. Thus, previously identified low rates of EAI ownership may be partly due to GPs not prescribing this medication to patients for whom it would be appropriate to do so. These data suggest that there is a need for improvement of the quality of care for high risk food-allergic patients in primary care.
Literature
1.
go back to reference Flokstra-de Blok BM, Doriene van Ginkel C, Roerdink EM, Kroeze MA, Stel AA, van der Meulen GN, et al. Extremely low prevalence of epinephrine autoinjectors in high-risk food-allergic adolescents in Dutch high schools. Pediatr Allergy Immunol. 2011;22(4):374–7.CrossRefPubMed Flokstra-de Blok BM, Doriene van Ginkel C, Roerdink EM, Kroeze MA, Stel AA, van der Meulen GN, et al. Extremely low prevalence of epinephrine autoinjectors in high-risk food-allergic adolescents in Dutch high schools. Pediatr Allergy Immunol. 2011;22(4):374–7.CrossRefPubMed
2.
go back to reference Klemans RJB, Le TM, Sigurdsson V, Enters Weijnen CF, van Hoffen E, Bruijnzeel-Koomen CAFM, Knulst AC. Management of acute food allergic reactions by general practitioners. Eur Ann Allergy Clin Immunol. 2013;45(2):43–51.PubMed Klemans RJB, Le TM, Sigurdsson V, Enters Weijnen CF, van Hoffen E, Bruijnzeel-Koomen CAFM, Knulst AC. Management of acute food allergic reactions by general practitioners. Eur Ann Allergy Clin Immunol. 2013;45(2):43–51.PubMed
3.
go back to reference Lowe G, Kirkwood E, Harkness S. Survey of anaphylaxis management by general practitioners in Scotland. Scott Med J. 2010;55(3):11–4.CrossRefPubMed Lowe G, Kirkwood E, Harkness S. Survey of anaphylaxis management by general practitioners in Scotland. Scott Med J. 2010;55(3):11–4.CrossRefPubMed
4.
go back to reference Kastner M, Harada L, Waserman S. Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature. Allergy. 2010;65(4):435–44.CrossRefPubMed Kastner M, Harada L, Waserman S. Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature. Allergy. 2010;65(4):435–44.CrossRefPubMed
5.
go back to reference Waserman S, Chad Z, Francoeur MJ, Small P, Stark D, Van der Leek TK, Kaplan A, Kastner M. Management of anaphylaxis in primary care: Canadian expert consensus recommendations. Allergy. 2010;65(9):1082–92.PubMed Waserman S, Chad Z, Francoeur MJ, Small P, Stark D, Van der Leek TK, Kaplan A, Kastner M. Management of anaphylaxis in primary care: Canadian expert consensus recommendations. Allergy. 2010;65(9):1082–92.PubMed
6.
go back to reference Agache I, Ryan D, Rodriguez MR, Yusuf O, Angier E, Jutel M. Allergy management in primary care across European countries—actual status. Allergy. 2013;68(7):836–43.CrossRefPubMed Agache I, Ryan D, Rodriguez MR, Yusuf O, Angier E, Jutel M. Allergy management in primary care across European countries—actual status. Allergy. 2013;68(7):836–43.CrossRefPubMed
7.
go back to reference Jutel M, Angier L, Palkonen S, Ryan D, Sheikh A, et al. Improving allergy management in the primary care network–a holistic approach. Allergy. 2013;68(11):1362–9.CrossRefPubMed Jutel M, Angier L, Palkonen S, Ryan D, Sheikh A, et al. Improving allergy management in the primary care network–a holistic approach. Allergy. 2013;68(11):1362–9.CrossRefPubMed
8.
go back to reference Singh J, Aszkenasy OM. Prescription of adrenaline auto-injectors for potential anaphylaxis–a population survey. Public Health. 2003;117(4):256–9.CrossRefPubMed Singh J, Aszkenasy OM. Prescription of adrenaline auto-injectors for potential anaphylaxis–a population survey. Public Health. 2003;117(4):256–9.CrossRefPubMed
9.
go back to reference Gupta RS, Kim E, Smith J, Pongracic, Wang J, Holl XB. Food allergy knowledge, attitudes, and beliefs of primary care physicians. Pediatrics. 2010;125(1):126–32.CrossRefPubMed Gupta RS, Kim E, Smith J, Pongracic, Wang J, Holl XB. Food allergy knowledge, attitudes, and beliefs of primary care physicians. Pediatrics. 2010;125(1):126–32.CrossRefPubMed
10.
go back to reference Pumphrey RS. Fatal anaphylaxis in the UK, 1992–2001. Novartis Found Symp. 2004;257:116–28 (discussion 128–32, 157–60, 276–85).CrossRefPubMed Pumphrey RS. Fatal anaphylaxis in the UK, 1992–2001. Novartis Found Symp. 2004;257:116–28 (discussion 128–32, 157–60, 276–85).CrossRefPubMed
11.
go back to reference Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol. 2007;119(4):1016–8.CrossRefPubMed Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol. 2007;119(4):1016–8.CrossRefPubMed
12.
go back to reference MacKenzie H, Roberts G, van Laar D, Dean T. Teenagers’ experiences of living with food hypersensitivity: a qualitative study. Pediatr Allergy Immunol. 2010;21(4 Pt 1):595–602.PubMed MacKenzie H, Roberts G, van Laar D, Dean T. Teenagers’ experiences of living with food hypersensitivity: a qualitative study. Pediatr Allergy Immunol. 2010;21(4 Pt 1):595–602.PubMed
13.
go back to reference Sampson MA, Munoz-Furlong A, Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol. 2006;117(6):1440–5.CrossRefPubMed Sampson MA, Munoz-Furlong A, Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol. 2006;117(6):1440–5.CrossRefPubMed
14.
go back to reference Gallagher M, Worth A, CunninghamBurley S, Sheikh A. Strategies for living with the risk of anaphylaxis in adolescence: qualitative study of young people and their parents. Prim Care Respir J. 2012;21(4):392–7.CrossRefPubMed Gallagher M, Worth A, CunninghamBurley S, Sheikh A. Strategies for living with the risk of anaphylaxis in adolescence: qualitative study of young people and their parents. Prim Care Respir J. 2012;21(4):392–7.CrossRefPubMed
15.
go back to reference Marrs TL, Gideon. Why do few food-allergic adolescents treat anaphylaxis with adrenaline?—Reviewing a pressing issue. Pediatr Allergy Immunol. 2013;24(3):222–9.CrossRefPubMed Marrs TL, Gideon. Why do few food-allergic adolescents treat anaphylaxis with adrenaline?—Reviewing a pressing issue. Pediatr Allergy Immunol. 2013;24(3):222–9.CrossRefPubMed
16.
go back to reference Pinczower GD, Bertalli NA, Bussmann N, Hamidon M, Allen KJ, Dunn Galvin A, et al. The effect of provision of an adrenaline autoinjector on quality of life in children with food allergy. J Allergy Clin Immunol. 2013;131(1):238–240.e1.CrossRefPubMed Pinczower GD, Bertalli NA, Bussmann N, Hamidon M, Allen KJ, Dunn Galvin A, et al. The effect of provision of an adrenaline autoinjector on quality of life in children with food allergy. J Allergy Clin Immunol. 2013;131(1):238–240.e1.CrossRefPubMed
17.
go back to reference Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69(8):1008–25.CrossRefPubMed Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69(8):1008–25.CrossRefPubMed
18.
go back to reference Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, et al. The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunology. Allergy. 2007;62(8):857–71.CrossRefPubMed Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, et al. The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunology. Allergy. 2007;62(8):857–71.CrossRefPubMed
19.
go back to reference Leung D, Schatz M, Goldstein S. Consultation and referral guidelines citing the evidence: how the allergist-immunologist can help. J Allergy Clin Immunol 2006;117:S495–S523.CrossRef Leung D, Schatz M, Goldstein S. Consultation and referral guidelines citing the evidence: how the allergist-immunologist can help. J Allergy Clin Immunol 2006;117:S495–S523.CrossRef
20.
go back to reference Lucassen PLBJ, Albeda FW, Van Reisen MT, Silvius AM, Wensing C, Luning-Koster MN. NHG guideline food hypersensitivity. Huisarts Wet 2010;53(10):537–53.CrossRef Lucassen PLBJ, Albeda FW, Van Reisen MT, Silvius AM, Wensing C, Luning-Koster MN. NHG guideline food hypersensitivity. Huisarts Wet 2010;53(10):537–53.CrossRef
21.
go back to reference Pumphrey RS, Gowland MH. Further fatal allergic reactions to food in the United Kingdom, 1999–2006. J Allergy Clin Immunol. 2007;119(4):1018–9.CrossRefPubMed Pumphrey RS, Gowland MH. Further fatal allergic reactions to food in the United Kingdom, 1999–2006. J Allergy Clin Immunol. 2007;119(4):1018–9.CrossRefPubMed
22.
go back to reference Le TM, van Hoffen E, Pasmans SG, Bruijnzeel-Koomen CAFM, Knulst AC. Suboptimal management of acute food-allergic reactions by patients, emergency departments and general practitioners. Allergy. 2009;64(8):1227–8.CrossRefPubMed Le TM, van Hoffen E, Pasmans SG, Bruijnzeel-Koomen CAFM, Knulst AC. Suboptimal management of acute food-allergic reactions by patients, emergency departments and general practitioners. Allergy. 2009;64(8):1227–8.CrossRefPubMed
23.
go back to reference Gallagher M, Worth A, Cunningham-Burley S, Sheikh A. Epinephrine auto-injector use in adolescents at risk of anaphylaxis: a qualitative study in Scotland, UK. Clin Exp Allergy. 2011;41(6):869–77.CrossRefPubMed Gallagher M, Worth A, Cunningham-Burley S, Sheikh A. Epinephrine auto-injector use in adolescents at risk of anaphylaxis: a qualitative study in Scotland, UK. Clin Exp Allergy. 2011;41(6):869–77.CrossRefPubMed
24.
go back to reference Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001;107(1):191–3.CrossRefPubMed Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001;107(1):191–3.CrossRefPubMed
Metadata
Title
Epinephrine auto-injector prescriptions to food-allergic patients in primary care in The Netherlands
Authors
Jacquelien Saleh-Langenberg
A. E. J. Dubois
F. Groenhof
J. W. H. Kocks
T. van der Molen
B. M. J. Flokstra-de Blok
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Allergy, Asthma & Clinical Immunology / Issue 1/2015
Electronic ISSN: 1710-1492
DOI
https://doi.org/10.1186/s13223-015-0094-9

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