Järvinen KM, Sicherer SH, Sampson HA, Nowak-Wegrzyn A. J Allergy Clin Immunol. 2008;122(1): 133–138
PURPOSE OF THE STUDY. Data from mixed or adult populations indicate that 16% to 35% of anaphylactic reactions from various causes require >1 dose of epinephrine. This study sought to determine the prevalence and risk factors for administration of repeated doses of epinephrine in food-induced anaphylaxis in children.
STUDY POPULATION. Questionnaires (N = 542) were distributed to parents or caregivers of consecutive patients up to 18 years of age presenting for initial or follow-up evaluation for food allergy. The study was conducted at a hospital-based, pediatric, allergy clinic and a private practice-based, pediatric, food-allergy, referral clinic at Mount Sinai Hospital (New York, NY).
METHODS. An anonymous 2-page questionnaire regarding details of as many as 2 anaphylactic reactions was administered. Data collected from the past 2 reactions requiring epinephrine included suspect food, onset of symptoms, and timing of treatment with single or multiple doses of epinephrine. The Mann-Whitney rank-sum test was used to compare medians and the t test to compare means.
RESULTS. Overall, 413 questionnaires were included in the analysis. A total of 78 children reported 95 reactions for which epinephrine was administered. Of the 95 reactions, 77 (81%) required a single dose, 12 (13%) required 2 doses, and 6 (6%) required 3 doses of epinephrine. Peanut, tree nut, and cow's milk were responsible for >75% of the reactions requiring epinephrine. Children receiving >1 dose of epinephrine more often had asthma (P = .27), compared with those receiving 1 dose. The amount of food allergen ingested and the delay in administering the initial epinephrine dose were not risk factors for receiving multiple doses of epinephrine. Of the second doses of epinephrine, 94% were administered by a health care professional.
CONCLUSIONS. Nineteen percent of food-induced anaphylactic reactions in this referral population required >1 dose of epinephrine. Additional studies are required to identify risk factors for severe anaphylaxis and to aid in establishing guidelines for prescribing multiple doses of epinephrine autoinjectors for children with food allergies.
REVIEWERS COMMENTS. The retrospective design and selected referral-based population with multiple food allergies are limitations to this study. These results, however, contribute to a body of evidence that suggests 2 doses of epinephrine may be required for our at-risk food-allergic patients. It is hoped that with additional studies we will improve our ability to identify those food-allergic patients most at risk for severe anaphylaxis.
- Copyright © 2009 by the American Academy of Pediatrics