Food-related anaphylaxis therapy often suboptimal

By Megan Rauscher

NEW YORK (Reuters Health) - Survey results indicate that most food-allergic children who experience severe throat, respiratory and cardiovascular symptoms of anaphylaxis, a potentially fatal allergic reaction, do not receive epinephrine and many do not seek medical attention. For those who do seek medical care, their reported treatment is often suboptimal.

The results of this survey suggest that "there is a long way to go to improve the management of allergic reactions" in the community and medical setting, Dr. Elinor Simons said at the annual meeting of the American Academy of Allergy, Asthma and Immunology underway in Miami Beach.

Dr. Simons, from Mount Sinai School of Medicine in New York, and colleagues asked attendees of a Food Allergy and Anaphylaxis Network conference to describe treatment -- in the community and in the healthcare setting -- of anaphylaxis for their family's most severely food-allergic individual.

Among the 507 food-allergic individuals who were identified, 96 percent were children younger than age 18, Simons reported. During initial anaphylactic reactions, 38 percent of these children experienced severe, potentially life-threatening symptoms such as throat tightness or swelling, lower airway symptoms such as coughing or wheezing, and cardiovascular symptoms such as fainting or low blood pressure.

Despite the severity of their symptoms, only 6 percent received pre-hospital epinephrine and only 57 percent sought medical attention, Simons reported.

She also noted that during 271 subsequent "worst reactions," 66 percent had severe anaphylactic symptoms, 33 percent received pre-hospital epinephrine, and 75 percent sought medical attention. "So, although the children had slightly improved management with subsequent reactions, many of them with severe throat, respiratory or cardiovascular symptoms due to anaphylaxis from food did not receive optimal management," Simons pointed out.

The top reasons for not seeking medical attention were that the reaction did not seem to be severe enough (45 percent) or that the reaction was not recognized as severe (33 percent). "Interestingly," Simons said, in 16 percent of reactions, parents were advised by a physician that their child's symptoms did not require medical attention.

For children with severe symptoms of anaphylaxis who did receive care in the ER or a medical office, observation periods were too brief (50 percent were less than 2 hours), epinephrine was under-prescribed, and training on how to self-administer epinephrine and food avoidance instructions were "not ideal," Simons said.

"Physicians and families," she concluded, "must be educated to ensure that all food allergic individuals have self-injectable epinephrine available to them at all times, and that they are trained to use their epinephrine and seek medical attention promptly for any symptoms of anaphylaxis."