Managing Anaphylaxis and Food Allergy Reactions

San Francisco—An analysis of online questionnaires completed by parents of children with food allergies found that medical professionals only recognized and treated approximately one third of initial reactions to food allergies that led to anaphylaxis. In addition, approximately 40% of patients whose reactions were deemed as highly likely for anaphylaxis were referred to an allergist, leading the authors to conclude that there is a need for increased education and awareness of food-related anaphylaxis. The results were presented at the AAAAI meeting in a poster session titled A Survey Study of Food-Related Allergic Reactions and Anaphylaxis Management. The Kids with Food Allergies Foundation, a Pennsylvania-based nonprofit organization, designed a questionnaire with researchers from the Children’s Hospital of Pittsburgh, the University of Michigan’s Food Allergy Center, Ohio State University’s Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio. Parents were asked about their child’s first food-related allergic reaction that resulted in a visit to a physician, when the child had not been diagnosed as prone to food allergies. Parents completed the survey between July 2010 and January 2011, with reactions occurring between 0 and 18 years of age and between 1980 and 2010. The survey included questions regarding demographics, medical history, family history of allergies, time of onset of food allergy symptoms, treatments prescribed, and instructions that medical professionals provided at discharge. The authors defined anaphylaxis using the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) criteria, which indicates that anaphylaxis is highly likely if (1) there was an acute onset of the illness involving the skin/mucosal tissue as well as respiratory compromise and/or reduced blood pressure or (2) ≥2 of the following occurred rapidly after exposure to a likely allergen: skin/mucosal tissue involvement, respiratory compromise, reduced blood pressure, and persistent gastrointestinal symptoms. Of the 1300 surveys submitted, 988 met the NIAID/FAAN criteria for patients who were highly likely for anaphylaxis; 339 (34.3%) of those 988 patients received epinephrine compared with 24 (7.7%) of the 312 patients who did not meet the highly likely criteria. Among 339 patients receiving epinephrine in the highly likely group, 190 (56.1%) had the treatment administered in emergency departments, 68 (20.1%) had the treatment administered by their parents, 32 (9.4%) had the treatment administered by paramedics, 28 (8.3%) had the treatment administered in a primary care clinic, and 21 (6.2%) had the treatment administered in an urgent care center. The following variables were associated with undertreatment (no epinephrine): <12 months of age (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.71-2.99), milk inciting the food reaction (OR, 1.48; 95% CI, 1.11-1.96), egg inciting the food reaction (OR, 1.52; 95% CI, 1.01-2.27), ≥1 gastrointestinal symptom (OR, 1.35; 95% CI, 1.03-1.78), abdominal pain (OR, 1.56; 95% CI, 1.08-2.24), and diarrhea (OR, 1.64; 95% CI, 1.14-2.36). The following variables were associated with epinephrine treatment: history of asthma (OR, 1.39; 95% CI, 1.01-1.90), peanut inciting the food reaction (OR, 1.45; 95% CI, 1.09-1.94), tree nut inciting the food reaction (OR, 1.50; 95% CI, 1.02-2.18), transport by ambulance (OR, 4.28; 95% CI, 3.07-5.96), combination of skin/mucosal tissue and cardiovascular symptoms (OR, 2.59; 95% CI, 1.94-3.37), combination of skin/mucosal tissue and respiratory symptoms (OR, 2.55; 95% CI, 1.80-3.63), combination of cardiovascular and respiratory symptoms (OR, 2.66; 95% CI, 2.01-3.53), and combination of cardiovascular and gastrointestinal symptoms (OR, 2.04; 95% CI, 1.52-2.73). Of 363 patients treated with epinephrine, 152 (41.9%) were referred to an allergist, 98 (27.0%) were given an anaphylaxis emergency action plan, 171 (47.1%) were prescribed an epinephrine autoinjector, 36 (9.9%) received epinephrine autoinjectors, and 77 (21.2%) received instructions and training on how to use epinephrine autoinjectors. The authors noted that their study had limitations related to surveys such as parental recall bias. However, they said conducting a survey had advantages over other methods, including that they could analyze information beyond emergency departments (which is limited in chart review designs) and could include the management of medical professionals not typically found in medical records.