title: A survey study of index food-related allergic reactions and anaphylaxis management.
abstract: BACKGROUND
  Initial food-allergic reactions are often poorly recognized and under-treated.
  
  
  METHODS
  Parents of food-allergic children were invited to complete an online questionnaire, designed with Kids with Food Allergies Foundation, about their children's first food-allergic reactions resulting in urgent medical evaluation.
  
  
  RESULTS
  Among 1361 reactions, 76% (95% CI 74-79%) were highly likely to represent anaphylaxis based on NIAID/FAAN criteria. Only 34% (95% CI 31-37%) of these were administered epinephrine. In 56% of these, epinephrine was administered by emergency departments; 20% by parents; 9% by paramedics; 8% by primary care physicians; and 6% by urgent care centers. In 26% of these, epinephrine was given within 15 min of the onset of symptoms; 54% within 30 min; 82% within 1 h; and 93% within 2 h. Factors associated with a decreased likelihood of receiving epinephrine for anaphylaxis included age <12 months, milk and egg triggers, and symptoms of abdominal pain and/or diarrhea. Epinephrine was more likely to be given to asthmatic children and children with peanut or tree nut ingestion prior to event. Post-treatment, 42% of reactions likely to represent anaphylaxis were referred to allergists, 34% prescribed and/or given epinephrine auto-injectors, 17% trained to use epinephrine auto-injectors, and 19% given emergency action plans. Of patients treated with epinephrine, only half (47%) were prescribed epinephrine auto-injectors.
  
  
  CONCLUSIONS
  Only one-third of initial food-allergic reactions with symptoms of anaphylaxis were recognized and treated with epinephrine. Fewer than half of patients were referred to allergists. There is still a need to increase education and awareness about food-induced anaphylaxis.
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA.
authors.forename: Tammy S
authors.initials: TS
authors.lastname: Jacobs
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Greenhawt
authors.forename: David
authors.initials: D
authors.lastname: Hauswirth
authors.forename: Lynda
authors.initials: L
authors.lastname: Mitchell
authors.forename: Todd D
authors.initials: TD
authors.lastname: Green
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis; D000707:Anaphylaxis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D010367:Arachis / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003967:Diarrhea / Q000175:diagnosis; D004531:Eggs / Q000009:adverse effects; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007223:Infant; D008297:Male; D011795:Surveys and Questionnaires
chemical_list: D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D004837:Epinephrine