Use of multiple doses of epinephrine in food-induced anaphylaxis in children.
BACKGROUND
Food allergy is the most common cause of anaphylaxis outside the hospital setting.


OBJECTIVE
We sought to determine the rate, circumstances, and risk factors for repeated doses of epinephrine in the treatment of food-induced anaphylaxis in children.


METHODS
Anonymous questionnaires were distributed to families of children with food allergies during allergy outpatient visits to a food allergy referral center. Demographic information, allergy and reaction history, and details regarding the last 2 anaphylactic reactions requiring epinephrine were collected.


RESULTS
A total of 413 questionnaires were analyzed. Seventy-eight children (median, 4.5 years of age; range, 0.5-17.5 years) reported 95 reactions for which epinephrine was administered. Two doses were administered in 12 (13%) and 3 doses in an additional 6 (6%) reactions treated with epinephrine. Peanut, tree nuts, and cow's milk were responsible for >75% of reactions requiring epinephrine. Patients receiving multiple doses of epinephrine more often had asthma (P = .027) than children receiving a single dose. The amount of food ingested or a delay in the initial administration of epinephrine were not risk factors for receiving multiple doses. The second dose of epinephrine was administered by a health care professional in 94% of reactions.


CONCLUSIONS
In this referral population of children and adolescents with multiple food allergies, 19% of food-induced anaphylactic reactions were treated with more than 1 dose of epinephrine. Prospective studies are necessary to identify risk factors for severe anaphylaxis and to establish rational guidelines for prescribing multiple epinephrine autoinjectors for children with food allergy.
Division of Pediatric Allergy and Immunology and Jaffe Institute for Food Allergy, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. kirsi.jarvinen@mssm.edu
Kirsi M
KM
Järvinen
Scott H
SH
Sicherer
Hugh A
HA
Sampson
Anna
A
Nowak-Wegrzyn
D000293:Adolescent; D000322:Adrenergic Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000707:Anaphylaxis / Q000188:drug therapy* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005512:Food Hypersensitivity / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000322:Adrenergic Agonists; D004837:Epinephrine