Repeat epinephrine treatments for food-related allergic reactions that present to the emergency department.

Abstract

To date, there are sparse data on epinephrine treatment for food-related anaphylaxis in adults. We sought to establish the frequency of more than one epinephrine treatment for adult patients who present with food-related anaphylaxis to the emergency department (ED). We performed a chart review, at two academic centers, of all adults presenting to the ED for food allergy (ICD9CM codes 693.1, 995.0, 995.1, 995.3, 995.7, 995.60-995.69, 558.3, 692.5, and 708.X) between January 1, 2001 and December 31, 2006. We focused on causative foods; treatments, including the number of epinephrine treatments given before and during the ED visit; and disposition. Through random sampling and appropriate weighting, the 486 reviewed cases represented a study cohort of 1286 patients. The median age was 36 years and the cohort was 62% women. Shellfish (23%), peanuts (12%), tree nuts (14%), and fish (14%) provoked the allergic reaction most commonly. Most patients (62%; 95% confidence interval [CI], 57-68%) met criteria for food-related anaphylaxis. In the ED, anaphylaxis patients received epinephrine (18%), antihistamines (91%), corticosteroids (81%), and inhaled albuterol (19%). Overall, 17% (95% CI, 9-25%) of patients with food-related anaphylaxis given epinephrine received >1 dose over the course of their reaction. Among anaphylaxis patients admitted to the hospital, only 10% included anaphylaxis in the discharge diagnosis. At ED discharge (82% of patients), 18% were referred to an allergist and 39% were prescribed self-injectable epinephrine. Among ED patients with food-related anaphylaxis treated with epinephrine, 17% were given >1 dose. This study supports the recommendation that patients at risk for food-related anaphylaxis should carry 2 doses of epinephrine.

• Authors: Aleena Banerji, Susan A Rudders, Blanka Corel, Alisha M Garth, Sunday Clark, Carlos A Camargo Jr
• Journal: Allergy and asthma proceedings (Allergy Asthma Proc) 2010 Jul-Aug Vol. 31 Issue 4 Pg. 308-16 ISSN: 1539-6304 [Electronic] United States
• PMID: 20819321 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Epinephrine

Topics

• Adult
• Anaphylaxis
• Arachis (adverse effects)
• Clinical Protocols
• Emergency Service, Hospital (statistics & numerical data)
• Epinephrine (administration & dosage, therapeutic use)
• Female
• Food Hypersensitivity (diagnosis, drug therapy, epidemiology, physiopathology)
• Humans
• Male
• Medical Records
• Patient Education as Topic
• Risk Factors
• Shellfish (adverse effects)
• Treatment Outcome