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Children with food allergies should carry 2 doses of emergency medicine
Date:3/24/2010

smaller previous studies.

"Until we're able to clearly define the risk factors for the most severe reactions, the safest thing may be to have all children at risk for food-related anaphylaxis carry two doses of epinephrine," Rudders says. To offset the added cost, Rudders suggests that school nurse offices carry un-assigned extra doses of injectable epinephrine for the children who need them.

The study also characterized the state of anaphylaxis treatment in the two EDs. The study, spanning 2001-2006, suggests that EDs may not always follow current practice guidelines, which have not changed much since 1998. Current practice guidelines recommend a protocol for food-related anaphylaxis: doctors use epinephrine as the first line of treatment, refer patients to allergists, instruct patients to avoid suspected foods and prescribe self-injectable epinephrine.

However, consistent with trends seen nationwide, emergency physicians were more likely to treat children in the emergency department with corticosteroids and antihistamines. Upon discharge from the ED, less than half of patients were prescribed epinephrine, and even fewer were referred to an allergist or received instructions on avoiding suspected foods. These last recommendations are important in light of the fact that 44 percent of the children studied had a known history of food allergies, but still ate these foods accidentally.

These findings may be due to lack of a universal understanding of anaphylaxis in the ED before 2006, Rudders says. That gap in knowledge has been closing since, and Rudders hopes her study will move things forward.

"As food allergies are becoming more prominent in the media, some of these [shortcomings] will catch up," Rudders says. "Recognizing anaphylaxis, promptly treating with epinephrine and sending children home with self-injectable epinephrine are going to become increasingly important."


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Contact: Keri Stedman
keri.stedman@childrens.harvard.edu
617-919-3110
Children's Hospital Boston
Source:Eurekalert

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