Low compliance rate for food allergy treatment in emergency departments,
from the Journal of Allergy and Clinical Immunology

MILWAUKEE - A new study shows emergency departments have a low compliance rate with recommended treatment guidelines for food-related acute allergic reactions. These findings are featured in the February 2004 Journal of Allergy and Clinical Immunology (JACI). The JACI is the peer-reviewed, scientific journal of the American Academy of Allergy, Asthma and Immunology (AAAAI).

In a review of 21 North American emergency departments (ED), Sunday Clark, MPH, from the Department of Emergency Medicine at Massachusetts General Hospital in Boston, evaluated the medical records of 678 patients who presented with food allergy. All of the patients had a physician diagnosis of an acute allergic reaction related to food. A variety of foods provoked the allergic reaction, including nuts (21%), crustaceans (19%), fruit (12%), and fish (10%).

The study found:

• Only 18% of the patients arrived at the ED by ambulance, even though exposure to these foods can be life threatening.
• Only 16% of all patients were treated with epinephrine, the gold standard for treating allergic reactions to food. 72% of the patients received antihistamines, while 48% received systemic corticosteroids.
• Only 16% were prescribed self-injectable epinephrine when leaving the ED.
• Only 12% were referred to an allergist/immunologist.

Current guidelines for treating patients with allergic reactions to food recommend epinephrine as the gold standard of treatment, teaching the proper techniques for self-administration of epinephrine and referring the patient to an allergist/immunologist. However, based on the results from this study, compliance with the recommend guidelines appears to be very low, suggesting that further educational initiatives focus on ED patients and staff.

The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Established in 1943, the AAAAI has more than 6,500 members in the United States, Canada and 60 other countries. The AAAAI serves as an advocate to the public by providing educational information and a physician referral directory through its Web site at www.aaaai.org.

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