Reluctance to Use Epinephrine For Kids' Severe Food Allergies

Published Online: Friday, August 17, 2012

The results of a recent study show that cases of human papillomavirus are down due to vaccination, and research in the area of severe food allergies uncovers an alarming trend of caregivers failing to administer epinephrine.

Although allergic reactions to food occur more often than expected in preschool aged children, severe reactions were only treated with epinephrine in 30% of cases, the results of a study published in the July 1, 2012, edition of Pediatrics suggest.

The study authors, who are affiliated with the Consortium of Food Allergy Research, aimed to examine the situations leading up to an allergic reaction in preschool-aged children. Researchers followed infants aged 3 to 15 months at 5 observation sites over a 3-year period. All participants had either a documented milk or egg allergy or were likely to have a milk or egg allergy based on a skin prick test. Participants with known peanut allergies were excluded from the test. Data collection techniques included patient questionnaires, telephone interviews, and doctor’s visits.

Of the 512 participants, 173 had no confirmed baseline food allergy, 278 had a single food allergy, and 53 had allergies to both milk and eggs. When the study began, caretakers were counseled on avoiding trigger foods and creating written emergency plans in case of a severe allergic reaction.

During the 3-year period, 72% of participants had a food reaction, with more than half of participants having more than 1 reaction. Most reactions were triggered by milk, egg, and peanut allergies, with many being attributed to unintentional ingestion, label-reading errors, and accidental cross-contact.

Of the accidental exposures, parents provided the trigger food most often, followed by the study participants and relatives or caregivers. Ninety-two, or about 11.2%, of the reactions were from purposeful exposure to trigger foods, with parents being the most common providers. Participants self-feeding the trigger food were considered accidental due to their ages, researchers noted. Nonaccidental exposure was more likely to occur for milk or egg allergies compared with peanut allergies, the authors added.

Of the reactions, 11.4% were severe; however, only 29.9% were treated with epinephrine. According to the study, in most cases, caretakers did not recognize the severity of the reaction, did not have epinephrine available, or were anxious about administering the drug, despite education about the treatment and its safety.

Although additional research is needed, the study authors noted the benefits of additional counseling to prevent allergen exposure, as well as improved education on treatment of severe reactions.

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