Background
Although studies suggest underuse of epinephrine in food related allergic reactions, it is not clear whether treatment may differ over time in those who have already had an allergic reaction. We sought to characterize treatment of the most recent allergic reaction to peanut versus the initial allergic reaction.
Materials and methods
Individuals with an allergist-confirmed peanut allergy were recruited from the Montreal Children's Hospital and Canadian food allergy advocacy organizations. Data were collected on initial allergic reactions to peanut and most recent reaction to peanut during the year prior to study entry.
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Results
See Table 1
Table 1
Epinephrine +/- other medications | Other medications (excluding epinephrine) eg: antihistamines | None | |
|---|---|---|---|
Initial reactions, % (95% CI)
| 8.9% (5.2, 14) | 35.6% (28.6, 43) | 55.6% (48, 62.9) |
Mild | 0.0% (0, 6.4) | 28.6% (17.3, 42.2) | 71.4% (57.8, 82.7) |
Moderate | 7.7% (3.1, 15.2) | 37.4% (27.4, 48.1) | 54.9% (44.2, 65.4) |
Severe | 27.3% (13.3, 45.5) | 42.4% (25.5, 60.8) | 30.3% (15.6, 48.7) |
Treated only outside HCF | 0.0% (0, 9.3) | 100.0% (90.7, 100) | |
Treated only in HCF | 44.8% (26.4, 64.3) | 55.2% (35.7, 73.6) | |
Treated outside and in HCF | 40% (5.3, 85.3) | 60% (14.7, 94.7) | |
Location unknown | 12.5% (0.3, 52.7) | 87.5% (47.3, 99.7) | |
Most recent reactions % (95% CI)
| 17.2% (12, 23.5) | 62.2% (54.7, 69.3) | 20.6% (14.9, 27.2) |
Mild | 5.7% (1.2, 15.7) | 64.2% (49.8, 76.9) | 30.2% (18.3, 44.3) |
Moderate | 16.5% (9.7, 25.4) | 63.9% (53.5, 73.4) | 19.6% (12.2, 28.9) |
Severe | 40% (22.7, 59.4) | 53.3% (34.3, 71.7) | 6.7% (0.8, 22.1) |
Treated only outside HCF | 8.8% (3.9, 16.6) | 91.2% (83.4, 96.1) | |
Treated only in HCF | 20% (2.5, 55.6) | 80% (44.4, 97.5) | |
Treated outside and in HCF | 64% (42.5, 82) | 36% (18, 57.5) | |
Location unknown | 29.4% (10.3, 56) | 70.6% (44, 89.7) |
Among 180 individuals reporting both an initial allergic reaction and a recent allergic reaction to peanut, epinephrine was administered in 8.9% (95% CI, 5.2-14.0%) and 17.2% (95% CI, 12.0-23.5%) respectively. Treatments excluding epinephrine were given in 35.6% (95% CI, 28.6-43.0%) of initial reactions and in 62.2% (95% CI, 54.7-69.3%) of most recent reactions. Among those treated only outside health care facilities (HCFs) no participant received epinephrine in initial reactions versus almost 9% (95% CI, 3.9-16.6%) in most recent reactions. However, in initial reactions, 44.8% (95% CI, 26.4-64.3%) of those treated, only in HCFs received epinephrine compared to 20% (95% CI, 2.5-55.6%) in recent reactions. Almost 1/3(95% CI, 15.6-48.7%) of participants with a severe reaction did not receive any treatment for the initial reaction compared to 6.7% (95% CI, 0.8-22.1%) of those with a recent reaction.
Conclusions
Although there is higher use of epinephrine in recent reactions compared to initial reactions, it is still administered in only 40% of severe allergic reactions. Further, our results suggest decreased epinephrine use over time in those treated initially in HCFs concurrent with increased use of other treatments such as anti-histamines. Given that prompt administration of epinephrine is the principal therapy for food-related anaphylaxis, it is crucial to develop and distribute guidelines and education programs that would contribute to increase epinephrine use inside and outside HCFs.
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