Document Detail

Use of multiple doses of epinephrine in food-induced anaphylaxis in children.
MedLine Citation:
PMID:  18547626     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Food allergy is the most common cause of anaphylaxis outside the hospital setting. OBJECTIVE: We sought to determine the rate, circumstances, and risk factors for repeated doses of epinephrine in the treatment of food-induced anaphylaxis in children. METHODS: Anonymous questionnaires were distributed to families of children with food allergies during allergy outpatient visits to a food allergy referral center. Demographic information, allergy and reaction history, and details regarding the last 2 anaphylactic reactions requiring epinephrine were collected. RESULTS: A total of 413 questionnaires were analyzed. Seventy-eight children (median, 4.5 years of age; range, 0.5-17.5 years) reported 95 reactions for which epinephrine was administered. Two doses were administered in 12 (13%) and 3 doses in an additional 6 (6%) reactions treated with epinephrine. Peanut, tree nuts, and cow's milk were responsible for >75% of reactions requiring epinephrine. Patients receiving multiple doses of epinephrine more often had asthma (P = .027) than children receiving a single dose. The amount of food ingested or a delay in the initial administration of epinephrine were not risk factors for receiving multiple doses. The second dose of epinephrine was administered by a health care professional in 94% of reactions. CONCLUSION: In this referral population of children and adolescents with multiple food allergies, 19% of food-induced anaphylactic reactions were treated with more than 1 dose of epinephrine. Prospective studies are necessary to identify risk factors for severe anaphylaxis and to establish rational guidelines for prescribing multiple epinephrine autoinjectors for children with food allergy.
Kirsi M Järvinen; Scott H Sicherer; Hugh A Sampson; Anna Nowak-Wegrzyn
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2008-06-10
Journal Detail:
Title:  The Journal of allergy and clinical immunology     Volume:  122     ISSN:  1097-6825     ISO Abbreviation:  J. Allergy Clin. Immunol.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-08     Completed Date:  2008-07-29     Revised Date:  2009-01-27    
Medline Journal Info:
Nlm Unique ID:  1275002     Medline TA:  J Allergy Clin Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  133-8     Citation Subset:  AIM; IM    
Division of Pediatric Allergy and Immunology and Jaffe Institute for Food Allergy, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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MeSH Terms
Adrenergic Agonists / administration & dosage*,  therapeutic use
Anaphylaxis / drug therapy*,  immunology
Child, Preschool
Epinephrine / administration & dosage*,  therapeutic use
Food Hypersensitivity / drug therapy*,  immunology
Risk Factors
Grant Support
Reg. No./Substance:
0/Adrenergic Agonists; 51-43-4/Epinephrine
Comment In:
J Allergy Clin Immunol. 2009 Jan;123(1):267-8; author reply 268   [PMID:  18845329 ]

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