Swedish Allergists' View on the Role of Cortisone and the Formulation (Tablets or Self-Dissolving Film) for the Treatment of Acute Allergic Reactions

OBJECTIVES: There are no national guidelines addressing treatment of allergic reactions in Sweden. Cortisone is mentioned in some local treatment guidelines, but the precise role in the context of acute allergic reactions is unclear. The objective was to clarify (i) when in the treatment algorithm, and to what extent, cortisone is used in relation to the severity of the allergy, (ii) consequences for the patient in case of non-treatment, (iii) conditions for treatment in the acute situation (optimal vs. suboptimal situation) and (iv) advantages of different options, with a focus on cortisone tablets vs self-dissolving oral film (Zeqmelit®).

METHODS: Semi-structured interviews were conducted digitally with clinically experienced allergists in November 2023. A total of six allergists were contacted, of which five were willing to participate. A questionnaire was sent out before the interview and covered questions related to the study objectives (i) to (iv). The duration of each interview was approximately one hour. Each interview was recorded to facilitate transcription, which was sent to each participant to correct for any ambiguities and to avoid that any incorrect information was extracted from the interview.

RESULTS: According to the allergists, use of cortisone is primarily directed towards severe acute symptoms, where cortisone is a main option (4 out of 5) (4/5), and as adjunctive treatment (together with adrenaline and antihistamine) in anaphylaxis (4/5). The allergists (4/5) meant that the suboptimal situation is more common than the optimal situation as patients either are alone, stressed and/or have forgotten to bring the medicine or water. As Zeqmelit has properties that facilitate administration and compliance, allergists saw clear advantages with Zeqmelit vs cortisone tablets (5/5).

CONCLUSIONS: Cortisone has an important role in the treatment of severe acute allergic reactions in Sweden. As allergic reactions often occur in suboptimal situations, the allergists considered Zeqmelit to have clear advantages vs tablets.