Boston, Mass. In a large six-year review of emergency department (ED) data, researchers at Children's Hospital Boston, in collaboration with Massachusetts General Hospital, found that many children with severe food-related allergic reactions need a second dose of epinephrine, suggesting that patients carrying EpiPens should carry two doses instead of one.
Since 1997, the number of school-aged children with food allergies has increased nearly 20 percent, according to the Centers for Disease Control and Prevention. The study, publishing in the April issue of Pediatrics, is the largest to date to investigate emergency treatment of food-related anaphylaxis in children, according to the authors.
"Food allergies are an increasingly important topic in pediatrics," says Susan Rudders, MD, of Children's Division of Allergy and Immunology and first author of the paper. "There's not a lot of data about the epidemiology of food allergies because it's a hard thing to study." Difficulties imposed on previous studies included insensitive clinical tests for food allergies such as through a skin test or blood test and lack of a universally accepted definition of anaphylaxis.
In reviewing the charts of children under 18 seen in two Boston EDs from 2001 to 2006, the researchers identified 1,255 children who made visits for food-related allergic reactions. Of these, more than half had anaphylaxis, the most severe allergic reaction involving at least two organ systems or low blood pressure (as defined by the National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network in 2006). Common symptoms included trouble breathing, skin rashes, swelling and gastrointestinal problems.
Of those children with anaphylaxis who were treated with epinephrine, 12 percent needed more than one dose because of a resurgence of symptoms, either before or after being taken to the ED. This finding is consistent with those of
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Children's Hospital Boston