Children with food allergies should carry two doses of emergency medicine

Mar 24, 2010

In a large six-year review of emergency department (ED) data, researchers at Children's Hospital Boston, in collaboration with Massachusetts General Hospital, found that many children with severe food-related allergic reactions need a second dose of epinephrine, suggesting that patients carrying EpiPens should carry two doses instead of one.

Since 1997, the number of school-aged with food allergies has increased nearly 20 percent, according to the . The study, publishing in the April issue of Pediatrics, is the largest to date to investigate emergency treatment of food-related anaphylaxis in children, according to the authors.

"Food allergies are an increasingly important topic in pediatrics," says Susan Rudders, MD, of Children's Division of Allergy and Immunology and first author of the paper. "There's not a lot of data about the epidemiology of food allergies because it's a hard thing to study." Difficulties imposed on previous studies included insensitive clinical tests for food allergies - such as through a skin test or blood test - and lack of a universally accepted definition of anaphylaxis.

In reviewing the charts of children under 18 seen in two Boston EDs from 2001 to 2006, the researchers identified 1,255 children who made visits for food-related . Of these, more than half had anaphylaxis, the most severe allergic reaction involving at least two organ systems or low blood pressure (as defined by the National Institute of Allergy and Infectious Disease and the and Anaphylaxis Network in 2006). Common symptoms included trouble breathing, skin rashes, swelling and gastrointestinal problems.

Of those children with anaphylaxis who were treated with epinephrine, 12 percent needed more than one dose because of a resurgence of symptoms, either before or after being taken to the ED. This finding is consistent with those of smaller previous studies.

"Until we're able to clearly define the risk factors for the most severe reactions, the safest thing may be to have all children at risk for food-related anaphylaxis carry two doses of epinephrine," Rudders says. To offset the added cost, Rudders suggests that school nurse offices carry un-assigned extra doses of injectable epinephrine for the children who need them.

The study also characterized the state of anaphylaxis treatment in the two EDs. The study, spanning 2001-2006, suggests that EDs may not always follow current practice guidelines, which have not changed much since 1998. Current practice guidelines recommend a protocol for food-related anaphylaxis: doctors use epinephrine as the first line of treatment, refer patients to allergists, instruct patients to avoid suspected foods and prescribe self-injectable epinephrine.

However, consistent with trends seen nationwide, emergency physicians were more likely to treat children in the emergency department with corticosteroids and antihistamines. Upon discharge from the ED, less than half of patients were prescribed epinephrine, and even fewer were referred to an allergist or received instructions on avoiding suspected foods. These last recommendations are important in light of the fact that 44 percent of the children studied had a known history of food allergies, but still ate these foods accidentally.

These findings may be due to lack of a universal understanding of anaphylaxis in the ED before 2006, Rudders says. That gap in knowledge has been closing since, and Rudders hopes her study will move things forward.

"As food allergies are becoming more prominent in the media, some of these [shortcomings] will catch up," Rudders says. "Recognizing anaphylaxis, promptly treating with epinephrine and sending children home with self-injectable epinephrine are going to become increasingly important."

Explore further: Pollutants from coal-burning stoves strongly associated with miscarriages in Mongolia

add to favorites email to friend print save as pdf

Related Stories

Students with food allergies often not prepared

Aug 06, 2008

College students with food allergies aren't avoiding the foods they know they shouldn't eat. Students of all ages are not treated with potentially life-saving epinephrine as often as they should be. And instructors, ...

Of Mice and Peanuts: A new mouse model for peanut allergy

Jan 12, 2009

Chicago researchers report the development of a new mouse model for food allergy that mimics symptoms generated during a human allergic reaction to peanuts. The animal model provides a new research tool that will be invaluable ...

Allergies are increasing in Britain

Jul 24, 2006

A government review of allergy services in Britain finds that the number of people hospitalized for allergies has more than tripled in the past 10 years.

Researchers evaluating food allergy treatment

Apr 17, 2008

Researchers at National Jewish Medical and Research Center are conducting trials to evaluate a method to prevent allergic reactions to food. They are feeding peanut- and egg-allergic people increasing doses of an investigational ...

Recommended for you

High-calorie and low-nutrient foods in kids' TV

4 hours ago

Fruits and vegetables are often displayed in the popular Swedish children's TV show Bolibompa, but there are also plenty of high-sugar foods. A new study from the University of Gothenburg explores how food is portrayed in ...

Chemical companies shore up supplement science

4 hours ago

As evidence mounts showing the potential health benefits of probiotics, antioxidants and other nutritional compounds, more and more people are taking supplements. And the chemical industry is getting in on the action. But ...

More Americans in their golden years are going hungry

4 hours ago

In a country as wealthy as the United States, it may come as a surprise that one in 12 seniors do not have access to adequate food due to lack of money or other financial resources. They are food insecure.

User comments : 0

More news stories

Cyber buddy is better than 'no buddy'

A Michigan State University researcher is looking to give exercise enthusiasts the extra nudge they need during a workout, and her latest research shows that a cyber buddy can help.