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Substantial proportion of food-related anaphylactic reactions among children require multiple doses of epinephrine, study concludes

Wednesday, August 13 2008 | Comments

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What's This? Not uncommonly, children who experience anaphylactic reactions to food allergies require treatment with more than a single dose of epinephrine--the maximum amount typically carried by such patients--according to researchers who conducted a retrospective analysis of data provided by families of children with food allergies.

To analyze the rate, circumstances, and risk factors associated with the use of multiple doses of epinephrine in food-induced anaphylaxis among children, researchers gathered data from questionnaires returned by the parents or caregivers of 413 pediatric patients (median age, 4.5 years; range, 0.5-17.5 years) being evaluated for food allergy between September 2006 and February 2007. The researchers asked participants for information regarding demographics, allergy and reaction history, and details regarding the last 2 anaphylactic reactions requiring epinephrine. The majority of the children had multiple food allergies.

Of 95 epinephrine-treated reactions reported on the questionnaires for 78 children, 2 doses were administered in 12 cases (12.6%) and 3 doses in an additional 6 (6.3%). Approximately 75.0% of the reactions requiring epinephrine were related to peanut, tree nut, and cow's milk allergy. Patients who received multiple doses more often had asthma (P=.027) as compared with children receiving a single dose.

Cow's milk was responsible for 16.0% and 33.0% of reactions requiring single and multiple doses of epinephrine, respectively. The researchers noted that participants requiring epinephrine for cow's milk-related reactions were significantly younger (median, 2.2 years; range, 0.5-5.3 years) than those with peanut-induced or tree nut-induced anaphylaxis (median, 3.7 years; range, 1-13 years; P=.021). They added that cow's milk was responsible for 8% of 63 deaths recorded in a referenced U.S. food allergen-induced fatality registry.

The proportions of children with allergy to peanuts (8.2%), tree nuts (7.3%), and cow's milk (10.7%) who reported reactions to the food in question that were treated with epinephrine were not significantly different. In a subgroup analysis of those receiving a third dose of epinephrine, however, peanut was a more common trigger (P=.013) compared with reactions treated with just 2 doses.

The investigators noted that a health care professional administered the second dose of epinephrine in 94% of the reactions requiring a second dose and in 100.0% of cases requiring a third dose.

"Our results contribute to the evidence base required to identify risk factors for severe anaphylaxis, and to establish national guidelines for prescribing 1 or more doses of self-injectable epinephrine for the growing number of children at risk for anaphylaxis," the authors concluded, noting the existing data suggest that "the recommendation to carry 2 doses of epinephrine should at minimum be extended to individuals with asthma and significant food allergies." (Jarvinen KM et al. J Allergy Clin Immunol 2008;122:133-138.)

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