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Kids with food allergies need two EpiPens

By Elizabeth Cooney
Globe Correspondent / March 29, 2010

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Many children with food allergies carry EpiPens, which are self-injectible doses of epinephrine that can halt a severe allergic reaction called anaphylaxis. A study of emergency room treatment of children with these life-threatening reactions supports recommendations that children carry two EpiPens, not just one.

Dr. Susan Rudders of Children’s Hospital Boston led a review of more than 1,200 medical charts over six years from the emergency departments at Children’s and Massachusetts General Hospital. A little over half of the children who were seen for allergic reactions to food were suffering from anaphylaxis, which can include low blood pressure, difficulty breathing, and gastrointestinal problems. Among the patients who were given epinephrine either before or during their ER visit, 12 percent received a second dose.

The researchers also found that guidelines for care were not always being followed by emergency rooms. More children were given antihistamines or corticosteroids than the recommended epinephrine. Fewer than half left the hospital with a prescription for an EpiPen and fewer than a quarter were referred to an allergist.

“The results of our study indicate that food-related anaphylaxis continues to be underrecognized and inadequately treated in the [emergency department] setting,’’ the authors said.

BOTTOM LINE: Because 12 percent of children get a second dose of epinephrine when they go to hospital emergency rooms with severe food allergy reactions, children at risk should carry two doses of self-injectible epinephrine instead of one.

CAUTIONS: The study relied on medical charts from emergency departments that could have been inaccurate or incomplete.

WHERE TO FIND IT: Pediatrics, online March 22