Epinephrine Auto-Injector Prescription and Use: A Retrospective Analysis and Clinical Risk Assessment of Adult Patients Sensitized to Lipid Transfer Protein

Abstract

Lipid transfer proteins (LTPs) are widespread plant food allergens which represent the main cause of food allergy in adults living in the Mediterranean basin. We investigated the (1) occurrence of further food reaction in the following 3 years; (2) actual use of prescribed epinephrine auto-injector and need and frequency of access to first aid centers; (3) presence of possible predictive factors to further food reactions; and (4) appropriateness of the epinephrine prescription. A total of 165 adult patients sensitized to LTPs were included. During follow-up, we recorded 68 further reactions, most of them (77.9%) characterized by local symptoms; the patients rarely required emergency department visits (16.1%) and only one patient (1.7%) used the epinephrine auto-injector. The patients with a previous history of anaphylaxis at baseline turned back to first aid also during the follow-up (p = 0.006). The majority of patients with recorded systemic reactions (p = 0.004) and treated in an emergency room (p = 0.028) did not have any co-factor-enhanced at diagnosis. We noted a correlation between pollen platanus sensitization and severity of further reactions during the follow-up (p = 0.026). Epinephrine auto-injectors were prescribed to 108/165 patients (65.5%) with an over-prescription rate of 25%. The unforeseeable clinical presentation of LTP allergic reactions and the eventual role played by the cofactor make it necessary to schedule a follow-up to monitor the patients over time and to assess the actual use of epinephrine auto-injectors prescribed.