Background Data about epinephrine use and biphasic reactions in childhood food-induced anaphylaxis during oral food challenges are scarce. Objective To determine the prevalence and risk factors ...of reactions requiring epinephrine and the rate of biphasic reactions during oral food challenges (OFCs) in children. Methods Reaction details of positive OFCs in children between 1999 and 2007 were collected by using a computerized database. Selection of patients for OFCs was generally predicated on ≤50% likelihood of a positive challenge and a low likelihood of a severe reaction on the basis of the clinical history, specific IgE levels, and skin prick tests. Results A total of 436 of 1273 OFCs resulted in a reaction (34%). Epinephrine was administered in 50 challenges (11% of positive challenges, 3.9% overall) for egg (n = 15, 16% of positive OFCs to egg), milk (n = 14, 12%), peanut (n = 10, 26%), tree nuts (n = 4, 33%), soy (n = 3, 7%), wheat (n = 3, 9%), and fish (n = 1, 9%). Reactions requiring epinephrine occurred in older children (median, 7.9 vs 5.8 years; P < .001) and were more often caused by peanuts ( P = .006) compared with reactions not treated with epinephrine. There was no difference in the sex, prevalence of asthma, history of anaphylaxis, specific IgE level, skin prick tests, or amount of food administered. Two doses of epinephrine were required in 3 of 50 patients (6%) reacting to wheat, cow's milk, and pistachio. There was 1 (2%) biphasic reaction. No reaction resulted in life-threatening respiratory or cardiovascular compromise. Conclusion Older age and reactions to peanuts were risk factors for anaphylaxis during oral food challenges. Reactions requiring multiple doses of epinephrine and biphasic reactions were infrequent.
Reply Järvinen, Kirsi M; Amalanayagam, Sujitha; Bock, S Allan ...
Journal of allergy and clinical immunology,
07/2010, Letnik:
126, Številka:
1
Journal Article
Recenzirano
In Dr Bock's series, there were 372 food challenges, 81 (22%) were positive, and a total of 7 injections of epinephrine were given (unpublished data). ...epinephrine was used in 1.9% of total ...challenges and about 9% of positive challenges. The consistency in treatment of anaphylactic reactions is crucial. Because lack of timely treatment with epinephrine is a universal risk factor for a fatal food-induced anaphylaxis,4-7 reinforcing prompt treatment with epinephrine is essential in reducing the anxiety about administration of epinephrine, which may be an obstacle for appropriate use of epinephrine autoinjectors by parents, patients, and lay persons in out-of-hospital first aid situations.
Reply Järvinen, Kirsi M.; Amalanayagam, Sujitha; Bock, S. Allan ...
Journal of allergy and clinical immunology,
07/2010, Letnik:
126, Številka:
1
Journal Article
PDF
