title: Repeat epinephrine treatments for food-related allergic reactions that present to the emergency department.
abstract: To date, there are sparse data on epinephrine treatment for food-related anaphylaxis in adults. We sought to establish the frequency of more than one epinephrine treatment for adult patients who present with food-related anaphylaxis to the emergency department (ED). We performed a chart review, at two academic centers, of all adults presenting to the ED for food allergy (ICD9CM codes 693.1, 995.0, 995.1, 995.3, 995.7, 995.60-995.69, 558.3, 692.5, and 708.X) between January 1, 2001 and December 31, 2006. We focused on causative foods; treatments, including the number of epinephrine treatments given before and during the ED visit; and disposition. Through random sampling and appropriate weighting, the 486 reviewed cases represented a study cohort of 1286 patients. The median age was 36 years and the cohort was 62% women. Shellfish (23%), peanuts (12%), tree nuts (14%), and fish (14%) provoked the allergic reaction most commonly. Most patients (62%; 95% confidence interval [CI], 57-68%) met criteria for food-related anaphylaxis. In the ED, anaphylaxis patients received epinephrine (18%), antihistamines (91%), corticosteroids (81%), and inhaled albuterol (19%). Overall, 17% (95% CI, 9-25%) of patients with food-related anaphylaxis given epinephrine received >1 dose over the course of their reaction. Among anaphylaxis patients admitted to the hospital, only 10% included anaphylaxis in the discharge diagnosis. At ED discharge (82% of patients), 18% were referred to an allergist and 39% were prescribed self-injectable epinephrine. Among ED patients with food-related anaphylaxis treated with epinephrine, 17% were given >1 dose. This study supports the recommendation that patients at risk for food-related anaphylaxis should carry 2 doses of epinephrine.
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. abanerji@partners.org
authors.forename: Aleena
authors.initials: A
authors.lastname: Banerji
authors.forename: Susan A
authors.initials: SA
authors.lastname: Rudders
authors.forename: Blanka
authors.initials: B
authors.lastname: Corel
authors.forename: Alisha M
authors.initials: AM
authors.lastname: Garth
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000707:Anaphylaxis; D010367:Arachis / Q000009:adverse effects; D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008499:Medical Records; D010353:Patient Education as Topic; D012307:Risk Factors; D012758:Shellfish / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D004837:Epinephrine