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November 26, 2018 by Alan Khadavi

When multiple epinephrine doses are needed for food anaphylaxis

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.

 

Filed Under: Anaphylaxis, Blog

alan-khadavi
Dr. Alan Khadavi
Allergy & Asthma Specialist

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