Risk Factors for Multiple Epinephrine Doses in Food-Triggered Anaphylaxis in Children

Publication date: Available online 23 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Angela Tsuang, Nikhil R. Menon, Natasha Bahri, Lawrence S. Geyman, Anna Nowak-Węgrzyn
BackgroundFood-related anaphylactic reactions may require treatment with more than one dose of epinephrine. Current guidelines advise patients at risk of anaphylaxis to carry two epinephrine autoinjectors.ObjectiveThe objective of this study was to determine risk factors of multiple dose epinephrine treatment in pediatric food-related anaphylaxis.MethodsParents of children with physician-confirmed diagnosis of food allergy were administered a standardized questionnaire at the time of their clinic visit. These patients were then followed-up prospectively by phone.ResultsSix hundred forty-two subjects had allergic reactions. Twentysix percent of patients reported at least one reaction treated with epinephrine for a total of 221 reactions. Among reactions treated with epinephrine, twenty-four reactions (11%) received two or more doses of epinephrine. The most common triggers were milk (30%) and peanut (18%). Milk-triggered allergic reactions (odds ratio (OR) 3.2, 95% confidence interval (CI) 1.2-8.4) and treatment with oxygen (OR 5.0, 95% CI 2.0- 12.4) were significant risk factors for requiring multiple doses of epinephrine to treat an allergic reaction.ConclusionThis study demonstrates that treatment of anaphylaxis may require more than one epinephrine injection. Reactions triggered by milk or requiring treatment with oxygen are at higher risk for needing more than one dose of epinephrine. Families of food-allergic children should be counseled on the importance of carrying two epinephrine auto-injectors.



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