Food allergy

One EpiPen may not be enough

With food allergies on the rise, more children are carrying self-injectable epinephrine, better known as EpiPens, in case of severe anaphylactic reactions. A six-year review of emergency department data, published in the April issue of Pediatrics, now suggests that one EpiPen may not be enough.

Researchers at Children’s Hospital Boston, in collaboration with Massachusetts General Hospital, reviewed data from 1,255 children who visited an emergency department for food-related allergic reactions. More than half had anaphylaxis, and of those given epinephrine, 12 percent had a resurgence of symptoms (such as trouble breathing, skin rashes or swelling) requiring a second dose.

"Until we're able to clearly define who is at risk for the most severe reactions, it may be safest to have all children at risk for food-related anaphylaxis carry two doses of epinephrine," says first author Susan Rudders, MD, of Children's Division of Allergy and Immunology. She also suggests that school nurses could stock extra doses as a cost-saving approach.