Sometimes More Epinephrine Needed

Most parents of children who have truly serious, anaphylactic, food allergy reactions know to either have an epinephrine injector on them or to teach their children to always carry one when they're old enough to go off on their own.

The news service Reuters is reporting that an upcoming journal article warns that in almost 20% of cases, a single shot isn't enough. Two or even three injections are necessary.

As reported in an upcoming issue of the Journal of Allergy and Clinical Immunology, Dr. Kirsi M. Järvinen, from Mount Sinai School of Medicine in New York, and colleagues evaluated epinephrine use in children with food allergies by surveying the families of 413 patients.

Overall, 78 children, who were an average of 4.5 years old, were given epinephrine to treat a total of 95 reactions, the report indicates. Over 75 percent of these reactions involved peanut, tree nut, or cow's milk allergies.

Twelve (13 percent) of the reactions required two doses of epinephrine and an additional 6 (6 percent) required three doses, the researchers found.

Children who also had asthma were more likely to need multiple doses of epinephrine, whereas the amount of food eaten and delay of epinephrine treatment seemed to have no effect.

Journal of Allergy and Clinical Immunology, Volume 122, Issue 1, Pages 133-138 (July 2008), "Use of multiple doses of epinephrine in food-induced anaphylaxis in children," Kirsi M. Järvinen, MD, PhD, Scott H. Sicherer, MD, Hugh A. Sampson, MD, Anna Nowak-Wegrzyn, MD
abstract.