Original Articles: Systemic Allergic DisordersFood-induced anaphylaxis and repeated epinephrine treatments
Section snippets
INTRODUCTION
Food-induced anaphylaxis is a life-threatening acute allergic reaction that leads to at least 29,000 emergency department (ED) visits in the United States each year.1 In addition, approximately 125 to 150 deaths per year are attributed to food-induced anaphylaxis.1 Prompt recognition and treatment of these reactions are critical to preventing substantial morbidity and mortality.
In 2005 the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and
METHODS
This study was performed as an extension of an earlier study by Clark et al7 in 2004 that evaluated the management of food-induced allergic reactions in the ED. We obtained identifying information from this previously identified case series (found using International Classification of Diseases, Ninth Revision, codes 693.1, 995.0, 995.3, and 995.60-995.69) and, under the same institutional review board approval, reviewed the medical records of patients who presented to the Massachusetts General
RESULTS
Of 40 patients presenting to the Massachusetts General Hospital ED for food-induced reactions between June 1, 1999, and June 30, 2000, 39 medical records were available for review. Thirty-four patients were deemed to have had an acute allergic reaction due to food ingestion. Of these patients, 19 (56%) were considered to have met the criteria for anaphylaxis as defined by the 2005 symposium on the definition and management of anaphylaxis.3 Fourteen of the 34 patients (41%) with a food-induced
DISCUSSION
To our knowledge, this is the first study to document multiple epinephrine treatments administered in the management of anaphylaxis in the ED setting. We found that of 19 patients with food-induced anaphylaxis presenting to the ED of the Massachusetts General Hospital, 3 (16%) received 2 doses of epinephrine. Although statistical analysis was not possible, repeated epinephrine treatment occurred in patients with anaphylaxis to peanut or tree nut and hypotension. There was no apparent
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Dr Camargo has received funding for consulting and investigator-initiated research from Dey Laboratories and Verus Pharmaceuticals.