Children with Severe Food Allergies May Need Two Epi-Pens Nearby

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Children with severe food allergies and at an increased risk for anaphylaxis should carry two doses of self-injectable epinephrine, brand name Epi-Pen or Twinject, rather than just one according to a new study published in the April journal Pediatrics.

In a large six-year review of the emergency department data of 1,255 children under the age of 18, the researchers from Children’s Hospital in Boston found that among patients with anaphylaxis following food exposure, 12% needed more than one dose of epinephrine.

Common symptoms of anaphylaxis are trouble breathing, skin rashes, swelling, and gastrointestinal problems.

Those who needed the extra medication were more often older than ten years or were treated at another facility before transfer to the emergency department and had a resurgence of symptoms. 44% of the children knew they were allergic to the food source, but ate it accidentally.

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The researchers also found that “food-related anaphylaxis continues to be under-recognized and inadequately treated in the [emergency department] setting.” About half of the children in the study were not treated appropriately either before or while in the ED. Less than half were prescribed epinephrine, considered the first-line treatment for food-related anaphylaxis, and even fewer were referred to an allergist or given instructions on how to avoid suspected foods.

Food allergies have increased in recent years in the US by 20% since 1997, according to the Centers for Disease Control and Prevention. It is estimated that 3 million school-children are allergic. The top three food triggers are peanuts, tree nuts, and milk. Current guidelines for allergists are to prescribe self-injectable epinephrine, or Epi-Pen.

Most of the exposure to the food allergens was in the children’s homes, but about one-third were in other locations, emphasizing the necessity of keeping the syringes available and nearby at all times.

"Until we're able to clearly define the risk factors for the most severe reactions, the safest thing may be to have all children at risk for food-related anaphylaxis carry two doses of epinephrine," says Susan A. Rudders MD, lead study author. To offset the added cost, Rudders suggests that school nurse offices carry un-assigned extra doses of injectable epinephrine for the children who need them.

Source reference:
Rudders S, et al "Multicenter study of repeat epinephrine treatments for food-related anaphylaxis" Pediatrics 2010; DOI: 10.1542/peds.2009-2832.

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