Kids With Food Allergies May Need 2 EpiPens
Study Shows 1 Dose of Epinephrine Isn't Always Enough to Treat Severe Allergic Reactions
March 26, 2010 -- Children with a history of severe food
allergies should carry two doses of self-injectable epinephrine instead of one, a new study suggests.
Researchers reviewed outcomes among more than 1,200 children treated for
food allergies in emergency rooms at two large Boston
hospitals between 2001 and 2006.
During their allergic reactions, 44% were treated with epinephrine and about
one in 10 of these children needed more than one dose.
It is recommended that children and adults with a history of severe food
allergy reactions carry injectable epinephrine at all times.
The most widely prescribed self-administered epinephrine is the EpiPen auto injector.
Pediatric allergist and study researcher Susan Rudders, MD, of Children's
Hospital Boston, says the study confirms two pens offer more protection than
The research appears in the April issue of Pediatrics.
"Eighty-eight percent of kids were fine with just one pen, but 12% needed
two doses," she tells WebMD. "The problem is, we really don't have good ways of
identifying who will and will not need an extra dose."
Each year in the U.S., between 150 and 200 people die from anaphylaxis, a serious allergic reaction marked by
hives, swelling, and lowered blood pressure, after knowingly or
unknowingly eating foods they are allergic to, Rudders says.
Immediate treatment with injected epinephrine can keep these allergic
reactions from becoming life threatening.
But even in the hospital emergency department setting, anaphylaxis is often
misdiagnosed, she says.
Having symptoms in two or more systems of the body, such as hives and throat
swelling or trouble
breathing and skin
rashes, within 10 to 15 minutes of eating should raise suspicions of
The Boston study indicated that epinephrine is underused and practice
guidelines are not always followed.
Those guidelines recommend epinephrine as the first-line treatment for
food-related anaphylaxis in children. In addition, patients should be referred
to an allergist, taught about how to avoid problem foods, and be sent home with
Although 52% of the kids in the study received a diagnosis of food-related
anaphylaxis, just 31% received one dose of epinephrine, and 3% received more
than one dose before arriving at the hospital. Once there, 59% were treated
with antihistamines, 57% were treated with steroids, and
just 20% were treated with epinephrine.
At discharge, less than half (43%) of patients were prescribed
self-injectable epinephrine, and roughly one in five was referred to an
Peanuts, tree nuts, and milk triggered the most allergic reactions, but fruits
and vegetables, shellfish, and eggs were also implicated. In about one in
five cases, some another food caused the reaction.
Food Allergies on the Rise
According to the CDC, the number of Americans with food allergies has
increased by about 20% in just over a decade.
Mount Sinai School of Medicine professor of pediatrics Scott H. Sicherer,
MD, says his own research and the research of others has shown that two doses
of epinephrine are often needed.
"It has been the general practice here to advise most patients to carry two
doses of epinephrine," he says.
Sicherer tells WebMD that parents of children with food allergies need to
have an action plan in case anaphylaxis occurs.
"The most important thing is having epinephrine within reach and knowing how
and when to use it," he says. "Our own research shows that many times families,
and even physicians, don't know how to properly use it."