Repeat epinephrine treatments for food-related allergic reactions that present to the emergency department

To date, there are sparse data on epinephrine treatment for food-related anaphylaxis in adults. We sought to establish the frequency of more than one epinephrine treatment for adult patients who present with food-related anaphylaxis to the emergency department (ED). We performed a chart review, at two academic centers, of all adults presenting to the ED for food allergy (ICD9CM codes 693.1, 995.0, 995.1, 995.3, 995.7, 995.60‐995.69, 558.3, 692.5, and 708.X) between January 1, 2001 and December 31, 2006. We focused on causative foods; treatments, including the number of epinephrine treatments given before and during the ED visit; and disposition. Through random sampling and appropriate weighting, the 486 reviewed cases represented a study cohort of 1286 patients. The median age was 36 years and the cohort was 62% women. Shellfish (23%), peanuts (12%), tree nuts (14%), and fish (14%) provoked the allergic reaction most commonly. Most patients (62%; 95% confidence interval [CI], 57‐68%) met criteria for food-related anaphylaxis. In the ED, anaphylaxis patients received epinephrine (18%), antihistamines (91%), corticosteroids (81%), and inhaled albuterol (19%). Overall, 17% (95% CI, 9‐25%) of patients with food-related anaphylaxis given epinephrine received >1 dose over the course of their reaction. Among anaphylaxis patients admitted to the hospital, only 10% included anaphylaxis in the discharge diagnosis. At ED discharge (82% of patients), 18% were referred to an allergist and 39% were prescribed self-injectable epinephrine. Among ED patients with food-related anaphylaxis treated with epinephrine, 17% were given >1 dose. This study supports the recommendation that patients at risk for food-related anaphylaxis should carry 2 doses of epinephrine.