People are still dying of anaphylactic shock: the petition to ask for adrenaline auto-injectors

L’injection of adrenaline represents the treatment or first choice in the case of a reaction anaphylaxis. Yet, in our country, there is still a high number of deaths due to failure to promptly administer self-injectable adrenaline. The auto-injector is a device capable of delivering a pre-dosed amount of adrenaline, which represents a real life-saving in case of anaphylactic shock. The access framework to these devices in the various Italian regions, however, is not homogeneous and many allergic patients, at risk of anaphylactic shock, are often without adrenaline auto-injectors.

For this reason Food Allergy Italia APS has launched Shock, an information and awareness campaign on anaphylaxis, carried out with the patronage of Cittadinanzattiva and AIITO, the Italian Territorial and Hospital Allergists and Immunologists Association and with the unconditional support of Viatris.

L‘initiative provides for the creation of a petition “People still die of anaphylactic shock»Addressed to the top management of the competent institutions, to ask for certain and free availability of adrenaline auto-injectors. “Even today in Italy people die from anaphylaxis, this is because there is a difficulty and scarce attention on access to the adrenaline auto-injector by people at risk – he remembers Marcia Podestà, President of Food Allergy Italia APS – We are talking about a real problem of accessing the device. Unfortunately, despite the indications of the EMA and AIFA, there are still many Italian Regions that erroneously manage the supply of auto-injectors, for example by not prescribing two auto-injectors or not providing adequate training for the medical profession that can inform and train people. allergic to the use of adrenaline auto-injectors ”

The AIFA determination n. 202 of 31 August 2005 reclassified the drug in range H; therefore, since then it has been distributed by the National Health Service at the pharmacies of the hospital centers on the prescription of the hospital allergist or, in some Regions, of the general practitioner. The aim is to allow patients at risk to have access to the drug at any time and to use it in an emergency, especially if not in the vicinity of healthcare facilities. In 2015, the European Medicines Agency (EMA) recommended that doctors inform patients about the mechanisms of use of adrenaline auto-injectors and at the same time, for patients at risk of anaphylaxis, the prescription of two adrenaline auto-injectors to obviate any risk associated with a lack of effect of the administration.

«Symptoms that occur in the case of anaphylaxis include itching, erythema and urticaria, asthma, swelling of the tongue and larynx and involvement of the cardiovascular system (lowering of blood pressure and tachycardia). Symptoms can occur in different combinations. Airway obstruction and cardiovascular failure due to anaphylactic shock can be fatal – he says Riccardo Asero, President of AAIITO – Adrenaline is able to inhibit the release of the mediators responsible for inflammation from mast cells and basophils and directly counteract vasodilation, edema and bronchoconstriction. Clearly it must be administered in a timely manner and at the onset of the first symptoms. For this reason it is essential that all patients at risk are provided with the life-saving auto-injector. Patients must remember that adrenaline is a lifesaving drug and has passed through the NHS for free ”

It is possible that during an anaphylactic shock a single adrenaline auto-injector will not be enough. In the absence of clinical improvement or if deterioration occurs after initial treatment, or the device is not used correctly, further administration of self-injectable adrenaline is required. These potentially fatal risks could be avoided with a second adrenaline auto-injector. The indication of the prescription of the two auto-injectors was also acknowledged by AIFA. However, the actual implementation of the EMA recommendation, in Italy, appears incomplete and fragmented by the Regions and ASLs. The classification of the adrenaline auto-injector in Band H makes it difficult for the patient to access the life-saving drug for various reasons, both for the lack of allergological services that can quickly manage the therapeutic plan, and for the long lists waiting that do not allow the immediate prescription and the consequent disbursement. In order to heal the differences that exist between Regions, it is necessary to achieve territorial uniformity, providing for the provision, to those who are entitled, of the two adrenaline auto-injectors, as required by the 2015 EMA recommendations.

You can sign the petition HERE