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Some Parents Hesitant to Give Epinephrine for Severe Allergic Reactions

food allergy, egg allergy, epinephrine, FAAN

Most allergic reactions involving milk and egg involve skin reactions with anaphylaxis to these foods being less common. However, don’t discount the risk of life-threatening reactions. Researchers are finding that even food reactions that start off as less severe can turn into anaphylaxis in a significant number of children.

According to the Food Allergy and Anaphylaxis Network (FAAN), egg allergy is estimated to affect approximately 1.5% of young children. About 2.5% of children younger than the age of three are allergic to milk. Children with milk and egg allergies are more likely to outgrow these in the first few years of life. However, some children remain allergic to these foods for their lifetime, and even develop new allergies to foods such as peanuts.

Many children with milk and egg allergies are first diagnosed based on the presence of moderate-to-severe eczema, a chronic skin condition also known as atopic dermatitis. A study from the Consortium of Food Allergy Research (CoFAR) followed 512 infants aged 3 to 15 months who at study entry were allergic to milk or egg or who were likely to be allergic based on a positive skin test. Researchers carefully followed these children to see if their allergies resolved or if new allergies developed.

Over the course of three years, 72% of the children had a food-allergic reaction; 53% had more than one reaction, translating into a rate of nearly 1 food-allergic reaction per child per year. Approximately 11% of these were classified as severe and included symptoms such as swelling in the throat, difficulty breathing, a sudden drop in blood pressure, dizziness or fainting.

In 90% of the cases, the child accidentally ate the food, rather than touching it or inhaling it. The reasons for accidental exposure included misreading of food labels or not checking the ingredient list for an allergen or unintentional cross-contamination.

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Disturbingly, in only 30% of the severe reactions did caregivers administer epinephrine, a drug that reverses the symptoms of such reactions and can save lives. Reasons included not having the drug available, being afraid to administer it, or not recognizing the symptoms as being a severe allergic reaction.

Another distressing trend found in the study was the intentional exposure to a food allergen. Approximately 11% of reactions to egg, milk or peanut occurred after a caregiver provided the food intentionally. "Intentional exposures to allergenic food are typically reported in teenagers, who tend to take more risks or who might be embarrassed about their food allergy," says David Fleischer, M.D., the lead study author. Some parents also reported “testing” their child to see if they have outgrown the allergy.

"This study reinforces the importance of doctors, parents and other caregivers working together to be even more vigilant in managing food allergy in children," said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

"Areas for improved education include the need for constant vigilance, accurate label reading, avoidance of non-accidental exposure, prevention of cross-contamination, appropriate epinephrine administration, and education of all caretakers," conclude the authors.

The Food Allergy and Anaphylaxis Network is an excellent resource for parents and caregivers of food-allergic children. In addition to education about what foods to avoid, there are recipes, news about allergen-related food recalls, and Daily Tips. Much of the site is free, however, if you are a FAAN member, you receive additional benefits such as a place to “Ask the Expert” questions about how to keep your child safe.

Journal Reference:
Fleischer DM et al. Allergic reactions to foods in preschool children enrolled in a prospective observational food allergy study. Pediatrics, 2012; DOI:10.1542/peds.2011-1746



How can the society expect children to understand why this is happening to them? What kind of a life is 'constant vigilance', constant fear of misreading the labels? And adrenalin can invoke adrenal insufficiency if too often used. How can we not empathise with the allergic teenagers need to test and experiment? Why can't we avoid producing allergenic food altogether? Rather than making the allergic individuals' burden heavier, we ought to discover new solutions.