Physician Prescription Patterns of Epinephrine Autoinjectors in Oral Allergy Syndrome
Monday, March 5, 2018
South Hall A2 (Convention Center)
Gregory A. Rosner, MD, Luz S. Fonacier, MD FAAAAI
RATIONALE: Oral Allergy Syndrome (OAS) has been a challenging diagnosis due to lack of clear standardized diagnostic criteria and guideline based therapy. We sought to evaluate prescription patterns and reported use of Epinephrine autoinjectors (EAI) in patients with OAS.

METHODS: IRB approved retrospective chart review of patients seen in our Allergy/Immunology office. Patients with ICD 9/10 diagnostic codes related to OAS over the last seven years were identified. Patients with a diagnosis of OAS, and documentation of aeroallergen IgE sensitivity were included. Patients with a history of systemic reaction or anaphylaxis, and the need for EAI for an alternative reason were excluded.

RESULTS: Fifty patients were identified. The average age was 29 years (range 6-71) and 68% were female. EAI was prescribed to 5 of 29 (17%) patients with history of reaction to fruits/vegetables and 14 of 21 (66%) patients who had reacted to tree nuts or peanuts. Three of 5 (60%) patients in the fruit/vegetable group and 11 of the 14 (79%) patients in the tree nut/peanut group had positive skin-prick testing to one of their food allergens. Nineteen patients were seen for follow up visits and no patients from either group who were prescribed EAI required its use.

CONCLUSIONS: Our data suggests that EAI are prescribed more frequently in patients with a history of OAS to tree nuts and peanuts compared to fruits/vegetables. There was no increased incidence of systemic symptoms or anaphylaxis, questioning the need for prescribing EAI in OAS. Larger studies are needed to further evaluate this patient population.