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Wednesday, March 31, 2010

Kids May Need Two EpiPens

A major study just out in the journal Pediatrics (Rudders, Susan Pediatrics, April 2010; vol 125: pp: e711-e718) has been making headlines in newspapers all over the country. Dr. Rudders' teams looked at 1255 children who were admitted to emergency rooms at two large Boston hospitals between 2001 and 2006. All the children were under 18, but the average age was closer to six. Just over half (52%) of the children had a true anaphylactic reaction. Of these 44% received epinephrine and 12% of these needed two shots. Some of these shots were given at home, some at the hospital.

That's an awful lot of anaphylactic children who received no epinephrine at all. A Reuters article summed up the study's findings of the failings.

What's troubling, the researchers say, is that half of the children with food-induced anaphylactic reactions did not get epinephrine either before getting to the hospital or while at the hospital. At the hospital, the children received antihistamines, steroids, intravenous fluids and inhaled medicines more often than epinephrine, "despite the lack of evidence" for their usefulness as a first-line treatment, the authors note.

Additionally, fewer than half of the children with food-related allergic reactions left the hospital with a prescription for self-injectable epinephrine and only 22 percent were advised to see an allergist.

Clearly, food-related anaphylaxis "continues to be under-recognized and inadequately treated," Rudders and colleagues warn. Estimates suggest that approximately 150 to 200 people die each year from food-related anaphylactic reactions, and delayed or lack of administration of epinephrine is often to blame.


UPI had a further important quote.
"Until we're able to clearly define the risk factors for the most severe reactions, the safest thing may be to have all children at risk for food-related anaphylaxis carry two doses of epinephrine," first author Dr. Susan Rudder says in a statement.

To offset costs, Rudders suggests, school nurses carry un-assigned extra doses of injectable epinephrine for the children who need them.

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