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Use of Multiple Doses of Epinephrine in Food-Induced Anaphylaxis in ChildrenKirsi M. Järvinen, MD, PhD, Scott H. Sicherer, MD, Hugh A. Sampson, MD, and Anna
Nowak-Wegrzyn, MD In 1935, Dr H. J. Friedman described the death of a 6-year-old boy within 8 minutes of a skin test to horse serum. Today that child would have received potentially life-saving epinephrine in one or two doses. A review of the history of epinephrine use shows that in 1897, John Abel prepared crude adrenal extracts and named them epinephrine. By the start of the 20th century, chemists were able to extract and concentrate epinephrine from the adrenal glands resulting in the isolation of epinephrine (adrenaline) as the first hormone that could be used as a medicine. Responding to the scarcity of information about epinephrine use in childhood food-induced anaphylaxis, the authors of this article from the July 2008 issue of the Journal of Allergy and Clinical Immunology sought to find out the rate, circumstances, and risk factors for the use of repeated doses of epinephrine in the treatment of food-induced anaphylaxis in children. The researchers studied the histories of 413 food-allergic children (median age, 4 ½ years); 78 of those children received epinephrine to treat their food-induced anaphylactic reactions and 19% were administered a second dose and 6% received a third dose of epinephrine. Peanuts, tree nuts and cow's milk were found to be the cause of more than 75% of these anaphylactic reactions. The patients who received two or more doses more frequently had asthma than the patients receiving a single epinephrine dose. The second and the third dose of epinephrine were usually given within 30 minutes of the previous dose, indicating that the need for more epinephrine is not a result of the biphasic nature of the reactions, but the lack of response to the initial dose. This study underscores the importance of identifying risk factors for life-threatening anaphylaxis and the need to establish guidelines for prescribing multiple doses of self-injectable epinephrine for children at risk for food-induced anaphylaxis. 1 Anaphylaxis and the American Academy of Allergy, Asthma, and Immunology. Journal of Allergy and Clinical Immunology, Volume 117, Issue 2, Pages 478 - 482 P. Lieberman, M. Kaliner, R. Lockey, F. Simons 2 http://www.indmedica.com/journals.php?journalid=3&issueid=65&articleid=836&action=article-accessed 6/11/08 |
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