Introduction: Anaphylaxis is a life-threatening systemic hypersensitivity reaction that occurs quickly after contact with an allergen. It requires immediate treatment with the treatment of choice being an intramuscular injection of adrenalin. In Slovenia, the Epipen autoinjector is available.
Aim: To examine the patterns of adrenaline autoinjector prescription in Slovenia between 2012 and 2019 and compare the primary care prescribing patterns with foreign prescription guidelines.
Methods: Pharmacoepidemiological study was done using the anonymised prescription data provided by the Health Insurance Institute of Slovenia. The study was performed with data analysis tools SPSS and Excel.
Results: In the observed period, the number of patients with prescribed adrenaline autoinjectors has had a 2.97-fold increase. In 2019, the number of prescriptions were 231.3% higher than in 2012. In the paediatric group, 64.3% of the patients were male, however this gender difference lessens with age. Children represent 33.9% of total patients. On average, autoinjectors are prescribed to 1100 new patients each year. For these patients this is either their first prescription or their first prescription after a multi-year period without an existing prescription. The evaluated prevalence is on average 0.13% and the evaluated incidence is 0.05% or 53.2 per 100.000 people. The number of two simultaneously prescribed autoinjectors has increased 3.1-fold, however the number of single autoinjector prescriptions has also increased 3.4-fold. Primary care prescribing therefore follows Slovenian guidelines. In the observed period, 37.9% of patients have received a single autoinjector, 24% of patients received 2, however in 29.5% of these prescriptions, the 2 autoinjectors were prescribed together. In the observed period, 38.1% of patients have renewed their prescriptions multiple times and have received from 3 to 35 autoinjectors. 51% of observed patients have had their prescriptions renewed regularly. They first received the prescribed autoinjectors between 2012 and 2016, and then again between 2017 and 2019. 53.2% of patients have renewed their prescription at least once in the observed period with the mean time between prescriptions being 15 months. 90% of these patients have renewed their prescriptions within 2 years. The highest number of prescriptions were in the age group from 0 to 4 years. The number of prescriptions increases in the warmer months, however the seasonal impact is more apparent in new patients. Patients with autoinjector prescriptions often have simultaneous prescriptions for antihistamines, proton pump inhibitors, paracetamol, glucocorticoids and bronchoselective β2-agonists. The value analysis has shown that the yearly insurance costs of adrenaline autoinjectors has risen by 330%, however the percentage of these costs (88.6%) has not changed significantly over the years. A discussion about reasonable prescription practices is necessary.
Conclusion: The prevalence and incidence of anaphylaxis has risen in the last couple of decades in Slovenia as well as in other countries. In addition to the increase in anaphylaxis cases, the possible cause for a higher number of autoinjector prescriptions may be the change in prescription directives, as well as improved patient adherence to treatment and a better classification of anaphylaxis from physicians.
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