Document Detail


Epinephrine treatment is infrequent and biphasic reactions are rare in food-induced reactions during oral food challenges in children.
MedLine Citation:
PMID:  20004784     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Data about epinephrine use and biphasic reactions in childhood food-induced anaphylaxis during oral food challenges are scarce.
OBJECTIVE: To determine the prevalence and risk factors of reactions requiring epinephrine and the rate of biphasic reactions during oral food challenges (OFCs) in children.
METHODS: Reaction details of positive OFCs in children between 1999 and 2007 were collected by using a computerized database. Selection of patients for OFCs was generally predicated on < or =50% likelihood of a positive challenge and a low likelihood of a severe reaction on the basis of the clinical history, specific IgE levels, and skin prick tests.
RESULTS: A total of 436 of 1273 OFCs resulted in a reaction (34%). Epinephrine was administered in 50 challenges (11% of positive challenges, 3.9% overall) for egg (n = 15, 16% of positive OFCs to egg), milk (n = 14, 12%), peanut (n = 10, 26%), tree nuts (n = 4, 33%), soy (n = 3, 7%), wheat (n = 3, 9%), and fish (n = 1, 9%). Reactions requiring epinephrine occurred in older children (median, 7.9 vs 5.8 years; P < .001) and were more often caused by peanuts (P = .006) compared with reactions not treated with epinephrine. There was no difference in the sex, prevalence of asthma, history of anaphylaxis, specific IgE level, skin prick tests, or amount of food administered. Two doses of epinephrine were required in 3 of 50 patients (6%) reacting to wheat, cow's milk, and pistachio. There was 1 (2%) biphasic reaction. No reaction resulted in life-threatening respiratory or cardiovascular compromise.
CONCLUSION: Older age and reactions to peanuts were risk factors for anaphylaxis during oral food challenges. Reactions requiring multiple doses of epinephrine and biphasic reactions were infrequent.
Authors:
Kirsi M Järvinen; Sujitha Amalanayagam; Wayne G Shreffler; Sally Noone; Scott H Sicherer; Hugh A Sampson; Anna Nowak-Wegrzyn
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Journal of allergy and clinical immunology     Volume:  124     ISSN:  1097-6825     ISO Abbreviation:  J. Allergy Clin. Immunol.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-16     Completed Date:  2010-01-12     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  1275002     Medline TA:  J Allergy Clin Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1267-72     Citation Subset:  AIM; IM    
Affiliation:
Division of Pediatric Allergy and Immunology and the Jaffe Institute for Food Allergy, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. kirsi.jarvinen@mssm.edu
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adolescent
Adrenergic Agonists / therapeutic use*
Allergens / adverse effects,  immunology*,  therapeutic use
Anaphylaxis / drug therapy*,  immunology
Child
Child, Preschool
Desensitization, Immunologic
Epinephrine / therapeutic use*
Female
Humans
Immunoglobulin E / blood
Infant
Male
Peanut Hypersensitivity / drug therapy*,  immunology
Skin Tests
Grant Support
ID/Acronym/Agency:
AI066738/AI/NIAID NIH HHS; AI44236/AI/NIAID NIH HHS; K12 HD052890/HD/NICHD NIH HHS; K23 AI059318/AI/NIAID NIH HHS; M01 RR000071/RR/NCRR NIH HHS; M01 RR000071-430565/RR/NCRR NIH HHS; M01 RR00071/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic Agonists; 0/Allergens; 37341-29-0/Immunoglobulin E; 51-43-4/Epinephrine
Comments/Corrections
Comment In:
J Allergy Clin Immunol. 2010 Jul;126(1):182; author reply 182-3   [PMID:  20569975 ]

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