Food allergies: Are hospitals prepared?

New research findings suggest that some food-allergic children may not be equipped with enough potentially life-saving medication to reverse a severe allergic reaction.

According to research to be published in an upcoming issue of the Journal of Allergy and Clinical Immunology, a second dose of epinephrine – the drug of choice for treating severe allergic reactions – was needed in nearly 1-of-5 cases of food-induced anaphylaxis in children.

Nearly all patients who required multiple doses of epinephrine also suffered from asthma.
Though further studies are needed, these findings point to asthma as a risk factor for severe anaphylaxis and could influence how epinephrine is prescribed to children.

Many children and adults at risk of severe allergic reactions are currently advised to carry only a single epinephrine auto-injector, which is administered when a severe reaction occurs.

In her study article, lead author Kirsi M. Järvinen, MD, PhD, writes that “the recommendation to carry two doses of epinephrine should as minimum be extended to individuals with asthma and significant food allergies.”

Järvinen and colleagues from Mount Sinai School of Medicine studied the histories of 413 food-allergic children. They identified 78 patients who had received epinephrine to treat a total of 95 anaphylactic reactions. Parents of the children were asked to recall the suspected food trigger, how rapidly symptoms developed and the timing of treatment.

Of the 95 reactions treated with epinephrine, a second dose of the medication was administered in 19 percent of cases (18 patients). A third dose was required in 6 percent of cases (6 cases).
Of those who received multiple doses, all but one (94 percent) were also diagnosed with asthma.
In a surprise finding, the survey results also indicated that many children did not receive epinephrine, despite past severe reactions. While 51 percent of total patients studied reported a past history of anaphylactic symptoms, only 20 percent had ever used epinephrine.

Anaphylaxis is a serious, potentially life-threatening allergic reaction that can affect the cardiovascular, respiratory or gastrointestinal systems of the body. An estimated 100-150 people in the United States die each year from anaphylaxis, according to the American Academy of Allergy, Asthma & Immunology (AAAAI). Anaphylaxis is most commonly caused by allergic reactions to food, insect stings and medication.

Food allergies affect 3 million American children, including 1 in 17 children under the age of 3, according to the AAAAI. Additionally, about 9 million children in the United States have asthma.