Trends in adrenaline (EpiPen) dispensing in Israel in 1997–2004

doi:10.1016/j.puhe.2006.08.017

Public Health

Volume 121, Issue 2, February 2007, Pages 144-147

https://doi.org/10.1016/j.puhe.2006.08.017 Get rights and content

Summary

Background

The prevalence of allergic diseases has increased over the last 20 years in the Western world. Reports on the growing use of adrenaline auto-injectors (EpiPen and EpiPen Jr) in several countries may point to increased rates of anaphylactic reactions, increased awareness of the risk of anaphylaxis or both.

Objectives

To evaluate the dispensing rate of EpiPen units in Israel from 1997 to 2004.

Methods

The database of the General Health Services (Clalit) was searched to determine the number of EpiPen units dispensed each year from 1997 to 2004. Data on mortality from anaphylaxis were derived from the Central Bureau of Statistics using International Classification of Diseases, 10th revision codes.

Results

The dispensing rate of EpiPen units rose gradually from 1689 in 1997 to 2981 in 2004; an overall increase of 76%. No case of death from anaphylaxis was reported from 1998 to 2000.

Conclusions

The dispensing rate of adrenaline auto-injectors has increased considerably over the last 8 years in Israel, although to a lesser degree than in other countries. This is probably a reflection of updated medical policies, in accordance with the clinical guidelines for the management of anaphylaxis and improved public education. Further studies are needed to determine the prevalence of anaphylactic reactions in Israel.

Introduction

Atopic diseases are an important source of patient morbidity and healthcare utilization. A recent study from the UK showed that 39% of children and 30% of adults have been diagnosed with one or more atopic conditions (allergic rhinitis, anaphylaxis, asthma, conjunctivitis, eczema/dermatitis, food allergy and urticaria/angioedema), and that allergic diseases account for 6% of all general practice consultations and 0.8% of all hospital admissions.¹

Anaphylaxis is a severe, rapidly progressive and potentially life-threatening allergic reaction. Potential triggers include foods, insect venom, latex rubber, medications and vaccines.² It occurs more commonly in the community than in healthcare settings.³

Adrenaline injection is the treatment of choice. Fatalities during anaphylaxis are usually due to delayed administration of adrenaline and to severe respiratory complications, cardiovascular complications or both.³ The standard of management for patients with a history of anaphylaxis is prescription of self-injectable adrenaline (EpiPen, EpiPen Jr) for first-aid treatment of subsequent reactions.³ Thus, adrenaline data provide a novel and practical approach for studying and monitoring the epidemiology of anaphylaxis in the community.⁴

The aim of the present study was to evaluate the dispensing rate of adrenaline in Israel over the last 8 years compared with other countries.

Section snippets

Methods

Data on the number of adrenaline injectors (EpiPen 0.3 mg and EpiPen Jr 0.15 mg) dispensed each year from 1997 to 2004 were derived using Business Objects software (1990) from the database of the Purchase Department, Division of Logistics and Infrastructure of the General Health Services (Clalit), which is the largest of the four health maintenance organizations in Israel, serving about 60% of the country's population. Data on mortality associated with anaphylaxis and asthma from 1998 to 2000

Results

Table 1 shows the number of EpiPen and EpiPen Jr units dispensed to patients each year from 1997 to 2004 by the General Health Services. The total dispensing rate of EpiPen units increased by 76% over the 8-year period; the dispensing rate of EpiPen 0.3 mg increased by 89%, and that of EpiPen Jr 0.15 mg increased by 59%. Considering that 60% of the Israeli population is insured by the General Health Services, the increased dispensing rate of EpiPen units most likely represents a true increase in

Discussion

The present study revealed an almost two-fold increase in the overall dispensing rate of EpiPen units from 1997 to 2004. The increase in the dispensing rate was considerably higher for EpiPen 0.3 mg than for EpiPen Jr 0.15 mg (89% vs. 59%). This difference is probably due to the exclusive use of the EpiPen Jr by children aged less than 8 years and weighing 15–28 kg. This group is characterized by fewer life-threatening anaphylactic reactions than older groups, although they have a higher

Acknowledgements

The authors thank Ziona Haklai from the Central Bureau of Statistics in Jerusalem for supplying the mortality data.

References (19)

S.F. Kemp et al.
Anaphylaxis: a review of causes and mechanisms
J Allergy Clin Immunol
(2002)
J.S. Klein et al.
Underreporting of anaphylaxis in a community emergency room
J Allergy Clin Immunol
(1995)
K. Bohlke et al.
Epidemiology of anaphylaxis among children and adolescents enrolled in a health maintenance organization
J Allergy Clin Immunol
(2004)
M.W. Yocum et al.
Epidemiology of anaphylaxis in Olmsted county: a population-based study
J Allergy Clin Immunol
(1999)
Y. Graif et al.
Allergic reactions to insect stings: results from a national survey of 10 000 junior high school children in Israel
J Allergy Clin Immunol
(2006)
G. Roberts et al.
Food allergy as a risk factor for life threatening asthma in childhood: a case-controlled study
J Allergy Clin Immunol
(2003)
I. Mitchell et al.
Near-fatal asthma: a population-based study of risk factors
Chest
(2002)
T. Shohat et al.
Differences in the prevalence of asthma and current wheeze between Jews and Arabs: results from a national survey of school children in Israel
Ann Allergy Asthma Immunol
(2002)
E. Picard et al.
Rate and place of death from asthma among different ethnic groups in Israel
Chest
(2002)

There are more references available in the full text version of this article.

Cited by (6)

Epinephrine Autoinjector Prescribing Trends: An Outpatient Population-Based Study in Olmsted County, Minnesota
2016, Journal of Allergy and Clinical Immunology: In Practice
Citation Excerpt :
Pharmacy data from Australia showed a 300% increase in epinephrine autoinjector prescriptions from 1998 to 2002.19 A study from Israel also showed that epinephrine autoinjector prescriptions increased by 76% from 1997 to 2004.20 Similarly, national health care data from the United Kingdom showed a 97% increase in epinephrine autoinjector prescriptions along with increased diagnoses of anaphylaxis between 2001 and 2005.21
The prescribing pattern of epinephrine over time is an indicator of the secular trend of anaphylaxis. However, it is not well known in a population level in the United States.
To evaluate the trend of prescriptions for epinephrine autoinjectors in Olmsted County, Minn, residents.
Outpatient prescriptions for epinephrine were identified among residents of Olmsted County, Minn, between January 1, 2004, and December 31, 2010. We used the first prescription per patient per year, and the first prescription per patient during the study period to calculate incidence rates. Incidence rates per 100,000 person-years were calculated using patients prescribed epinephrine per year as the numerator and age- and sex-specific counts of the population of Olmsted County as the denominator. The relationships of age group, sex, and year of prescription with incidence rates were assessed by fitting Poisson regression models using the SAS procedure GENMOD.
The overall incidence rate of epinephrine autoinjector prescriptions during the study period was 757 per 100,000 person-years (95% confidence interval: 740-774). The prescription rates per patient per year increased over time, with an annual rate of increase of 8% (P < .001), but the rates per patient remained stable (P = .077). For each year, incidence rates overall were higher in women compared with men (P < .001). From ages 0 to 19, incidence rates were higher in boys compared with girls. At age 20 and above, incidence rates were higher in women compared with men.
The overall rate of epinephrine autoinjector prescriptions increased, but the rate of first-time prescriptions was stable from 2005 to 2010. In childhood, boys were more likely to receive a prescription than girls, but this reversed in later ages.
Accidental digital self-injection of epinephrine: Debunking the myth
2010, Annals of Emergency Medicine
Analysis of adrenaline autoinjectors acquisition in Portugal over 15 years
2023, European Annals of Allergy and Clinical Immunology
Food allergies in developing and emerging economies: need for comprehensive data on prevalence rates
2012, Clinical and Translational Allergy
Epinephrine auto-injector pandemic
2012, Pediatric Emergency Care
Effect of instruction on the ability to use a self-administered epinephrine injector
2012, Israel Medical Association Journal

View full text

Original ResearchTrends in adrenaline (EpiPen) dispensing in Israel in 1997–2004

Summary

Background

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

Ann Allergy Asthma Immunol

Chest

Original Research
Trends in adrenaline (EpiPen) dispensing in Israel in 1997–2004