Multiple epinephrine dosages are sometimes need for anaphylaxis. Anaphylaxis is a severe, potentially fatal allergic reaction. Intramuscular epinephrine is the recommended treatment in the the setting of anaphylaxis and the current recommendation is for patients to carry 2 doses of self-injectable epinephrine.
Previous studies have evaluated food-induced allergic reactions that require multiple epinephrine injections in the emergency department. Among cases of food induced anaphylaxis, 2 or more epinephrine doses were administered in up to 17% of adult patients with anaphylaxis. In a study evaluating the pediatric population, 12% received multiple epinephrine injections from food induced anaphylaxis.
A recent study published in the Annals of Allergy Asthma and Immunology titled “Risk factors for multiple epinephrine doses in food-triggered anaphylaxis in children” looked at which pediatric population needed more than 1 dose of epinephrine.
Results:
The study found that 11% of reactions treated with epinephrine received more than 1 injection of epinephrine. Children with milk-triggered allergic reactions and those that needed oxygen were more likely to need more than 1 dose of epinephrine.
In addition, patients with asthma or subjects who reported albuterol use were more likely to have reactions treated with any epinephrine and more than 1 allergic reaction during the study period.
Discussion:
Prior studies have shown multiple epinephrine doses from food allergic reactions in a range from 8-19%. Patient education should emphasize the possibility of requiring a second dose of epinephrine and the importance of carrying 2 epinephrine auto-injectors.
Cow’s milk were shown to have a 3x odds of treatment of multiple doses of epinephrine, although peanut is a more common food allergen. Most milk triggered allergic reactions occurred at home. Milk allergy is increasing in relevance and heightened awareness regarding potential milk severity is necessary.
Conclusion:
Education is important to understand that multiple dosages of epinephrine may be necessary in food anaphylaxis (11%). It is more likely need in those who have milk allergy and asthma.