Magdalena Kraft1, Macarena Pia Knop2, Jean-Marie Renaudin3, Kathrin Scherer Hofmeier4, Claudia Pföhler5, Maria Beatrice Bilò6,7, Roland Lang8, Regina Treudler9, Nicola Wagner10, Thomas Spindler11, Jonathan O'B Hourihane12, Ioana Maris13, Alice Koehli14, Andrea Bauer15, Lars Lange16, Sabine Müller17, Nikolaos G Papadopoulos18,19, Bettina Wedi20, Anne Moeser21, Luis F Ensina22, Montserrat Fernandez-Rivas23,24, Ewa Cichocka-Jarosz25, George Christoff26,27, Blanca E Garcia28, Iwona Poziomkowska-Gęsicka29, Victoria Cardona24,30, Tihomir B Mustakov31, Uta Rabe32, Vera Mahler33, Linus Grabenhenrich1,34, Sabine Dölle-Bierke1, Margitta Worm1. 1. Division of Allergy and Immunology, Department of Dermatology Venerology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. 2. Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany. 3. Presidency, Allergy Vigilance Network, Nancy, France. 4. Division of Allergy, Department of Dermatology, University Hospital Basel, University of Basel, Basel, Switzerland. 5. Department of Dermatology, The Saarland University Medical Center, Homburg/Saar, Germany. 6. Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy. 7. Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy. 8. Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria. 9. Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Allergy Center (LICA)-Comprehensive Allergy Center, University Hospital, Leipzig, Germany. 10. Department of Dermatology, University Hospital of Erlangen-Nürnberg, Erlangen, Germany. 11. Allergy Campus Hochgebirgsklinik Davos, Davos, Switzerland. 12. DM University College Cork and Cork University Hospital, Cork, Ireland. 13. Bon Secours Hospital Cork/Department of Paediatrics and Child Health, University College Cork, Cork, Ireland. 14. Division of Allergology, University Children's Hospital Zurich, Zurich, Switzerland. 15. University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany. 16. Department for Pediatrics, St. Marien-Hospital, Bonn, Germany. 17. Department of Dermatology, Medical Center-University of Freiburg, Freiburg, Germany. 18. Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece. 19. Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK. 20. Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany. 21. Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany. 22. Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil. 23. Department of Allergy, Hospital Clinico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain. 24. ARADyAL Research Network. 25. Department of Pediatrics, Pulmonology, Allergy and Dermatology Clinic, Jagiellonian University Medical College, Krakow, Poland. 26. Faculty of Public Health, Medical University-Sofia, Sofia, Bulgaria. 27. Allergy Out-patient Department, Acibadem CityClinic, Tokuda Medical Centre, Sofia, Bulgaria. 28. Service of Allergology, Complejo Hospitalario de Navarra, Pamplona, Spain. 29. Clinical Allergology Department, Pomeranian Medical University in Szczecin, Szczecin, Poland. 30. Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain. 31. Chair of Allergy, Medical University Sofia, Sofia, Bulgaria. 32. Department for Allergy and Asthma, Johanniter Hospital, Treuenbrietzen, Germany. 33. Paul-Ehrlich-Institut, Langen, Germany. 34. Department for Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany.
Abstract
BACKGROUND: Patients with a history of anaphylaxis are at risk of future anaphylactic reactions. Thus, secondary prevention measures are recommended for these patients to prevent or attenuate the next reaction. METHODS: Data from the Anaphylaxis Registry were analyzed to identify secondary prevention measures offered to patients who experienced anaphylaxis. Our analysis included 7788 cases from 10 European countries and Brazil. RESULTS: The secondary prevention measures offered varied across the elicitors. A remarkable discrepancy was observed between prevention measures offered in specialized allergy centers (84% of patients were prescribed adrenaline autoinjectors following EAACI guidelines) and outside the centers: Here, EAACI guideline adherence was only 37%. In the multivariate analysis, the elicitor of the reaction, age of the patient, mastocytosis as comorbidity, severity of the reaction, and reimbursement/availability of the autoinjector influence physician's decision to prescribe one. CONCLUSIONS: Based on the low implementation of guidelines concerning secondary prevention measures outside of specialized allergy centers, our findings highlight the importance of these specialized centers and the requirement of better education for primary healthcare and emergency physicians.
BACKGROUND:Patients with a history of anaphylaxis are at risk of future anaphylactic reactions. Thus, secondary prevention measures are recommended for these patients to prevent or attenuate the next reaction. METHODS: Data from the Anaphylaxis Registry were analyzed to identify secondary prevention measures offered to patients who experienced anaphylaxis. Our analysis included 7788 cases from 10 European countries and Brazil. RESULTS: The secondary prevention measures offered varied across the elicitors. A remarkable discrepancy was observed between prevention measures offered in specialized allergy centers (84% of patients were prescribed adrenaline autoinjectors following EAACI guidelines) and outside the centers: Here, EAACI guideline adherence was only 37%. In the multivariate analysis, the elicitor of the reaction, age of the patient, mastocytosis as comorbidity, severity of the reaction, and reimbursement/availability of the autoinjector influence physician's decision to prescribe one. CONCLUSIONS: Based on the low implementation of guidelines concerning secondary prevention measures outside of specialized allergy centers, our findings highlight the importance of these specialized centers and the requirement of better education for primary healthcare and emergency physicians.