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.
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.
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.
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.