Published online July 2, 2007
PEDIATRICS Vol. 120 No. 1 July 2007, pp. 238 (doi:10.1542/peds.2007-0736)
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LETTER TO THE EDITOR

Self-injectable Epinephrine for First-Aid Management of Anaphylaxis

Alan D. Gaines, MD, FAAAI, FAAP
Department of Pediatrics
Warren Alpert School of Medicine
Brown University
Providence, RI 02906

To the Editor.—

Sicherer et al are to be commended for a fine, comprehensive article on the role of self-injectable epinephrine in the management of anaphylaxis.1 However, there is one misstatement that I feel should be corrected. In describing when self-injectable epinephrine should be prescribed, the authors stated that it should be prescribed to a child who has experienced generalized acute urticaria after an insect sting, "because the risk of a more severe reaction from a future sting is approximately 10%." However, the reference they give (a practice parameter update2) actually states that "patients 16 years of age and younger who have experienced cutaneous systemic reactions without other allergic manifestations have approximately a 10% chance of having a systemic reaction if re-stung. If a systemic reaction does occur, it is likely to be limited to the skin."

This is clarified even further in the original reference on which the above-mentioned statement was based,3 which stated that "196 stings in 86 untreated children resulted in 18 systemic reactions... . Sixteen of these 18 reactions were judged to be milder than the patient's reaction to the first sting, 2 were similar in severity, and none were more severe." Therefore, although it is certainly not unreasonable to prescribe self-injectable epinephrine for children with cutaneous-only reactions to insect stings, we can also be quite reassuring to patients and caregivers that the chances of a more severe reaction are, in fact, very small.

REFERENCES

  1. Sicherer SH, Simons FE; American Academy of Pediatrics, Section on Allergy and Immunology. Self-injectable epinephrine for first-aid management of anaphylaxis. Pediatrics. 2007;119 :638 –646[Abstract/Free Full Text]
  2. Moffitt JE, Golden DB, Reisman RE, et al. Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol. 2004;114 :869 –886[CrossRef][ISI][Medline]
  3. Valentine M, Schuberth K, Kagey-Sobotka A. The value of immunotherapy with venom in children with allergy to insect stings. N Engl J Med. 1990;323 :1601 –1603[Abstract]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics




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