New research on the treatment of anaphylaxis
presented at 2004 AAAAI Annual Meeting

Pediatricians and food-induced anaphylaxis
(SAN FRANCISCO, March 19, 2004) - More pediatrician education is needed regarding correct dosage and route of administering epinephrine, according to research presented at the 2004 Annual Meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI) in San Francisco.

P. Ponda, MD, and colleagues from Mount Sinai School of Medicine, New York, administered an anonymous survey to 61 pediatricians regarding treatment of food-induced anaphylaxis. The survey presented the case of a 12-year-old boy with peanut allergy and asthma who developed hives and cough within 30 minutes of ingesting a candy. The boy received initial treatment at home before being taken to the emergency department. Pediatricians were asked to answer questions regarding duration of observation, discharge medications and risk factors for food-induced anaphylaxis.

Results showed that epinephrine was indicated as the initial treatment by 91% of the pediatricians participating in the survey. However, only 48% would have administered the medication intramuscularly, which would have resulted in the highest level of absorption. Also, observation for four hours in the emergency department before being discharged was chosen by only 44%. Upon discharge, 85% did choose to prescribe epinephrine. Only 16 of the pediatricians surveyed correctly identified the risk factors for fatal food induced anaphylaxis (asthma, previous severe reactions and peanut allergy).

While epinephrine was recognized as the gold standard of treatment, many of the pediatricians selected the incorrect dose and route of administration. Also, more than one-third indicated an inadequate observation period prior to discharge. These results indicate that further efforts to educate pediatricians on the treatment of food-induced anaphylaxis are needed.

Treatment of anaphylaxis in the outpatient setting
A greater effort needs to made in educating healthcare providers that intramuscular injection of epinephrine is the preferred route of initial treatment of anaphylaxis, according to a study presented at the 2004 AAAAI Annual Meeting in San Francisco.

Bret R. Haymore, MD, William Beaumont Army Medical Center, El Paso, TX, and colleagues sought to identify how anaphylaxis is treated in the outpatient setting. The researchers reviewed records over the last two years with the primary diagnosis of anaphylaxis, angiodema or urticaria. They evaluated the dose, route and time of administration, epinephrine prescriptions and instruction on use.

Records of 28 patients having 31 episodes of anaphylaxis were reviewed. Eighty-four percent of the episodes were evaluated in the emergency department and 13% in primary care clinics. The study found that epinephrine was administered in only 52% of episodes and was given subcutaneously in 75% of these cases. None of the patients received intramuscular administration. Also, an epinephrine prescription was given in only 32% with documented instruction in only 16% of encounters. Researchers also found that referral to an allergy specialist was provided in only 35% of cases.

These findings offer further evidence that educational efforts are needed regarding the importance of intramuscular administration and providing epinephrine with proper training and referral to an allergist/immunologist.

Administering sublingual epinephrine
Sublingual administration of epinephrine may be a safe alternative for patients reluctant to self-inject themselves just before anaphylaxis occurs, according to a study presented at the 2004 AAAAI Annual Meeting in San Francisco.

For epinephrine, intramuscular administration is the gold standard of treatment. However, many patients are reluctant to self-inject and would prefer an alternate route of administration. While it is not possible to take it orally or through an inhaler, Keith J. Simons, PhD, and colleagues from the University of Manitoba, tested whether the sublingual route, administration beneath the tongue, might lead to rapid absorption.

Researchers tested healthy men by giving them epinephrine both sublingually and subcutaneously, or underneath the skin. Epinephrine levels, blood pressure and heart rate were measured at various intervals. No serious adverse effects were observed in any of the patients. Epinephrine absorption after sublingual administration was confirmed, suggesting this route of administration should be studied further.

Use of EpiPenŽ among parents of children with food allergies
Utilization of the EpiPenŽ by parents of children with food allergies is directly correlated with increased comfort level and perceived competence of proper administration, according to a study presented at the 2004 AAAAI Annual Meeting in San Francisco.

Jennifer S. Kim, MD, and colleagues from Children's Memorial Hospital in Chicago, sent a written survey to parents of 360 children with physician-diagnosed food allergies who had been prescribed the EpiPenŽ. The researchers wanted to determine how much the differences in parental comfort level could be explained by the self-perceived competence of proper EpiPenŽ use as well as knowledge of anaphylaxis.

Of the 165 completed surveys, anaphylaxis was reported by 70 parents (42.4%). Of these, only 14 (8.5%) had administered the EpiPenŽ to their child. The researchers found that the factors positively correlating with the parents' comfort level included prior administration and training with the EpiPenŽ, and their perceived ability to properly administer the medication to their child.

Based on the findings from the study, physicians should continue to instruct all parents on EpiPenŽ administration, specifically with a trainer. Other psychological factors may also contribute to underutilization of the EpiPenŽ and should be explored further.

These studies were presented at the 2004 Annual Meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI), taking place March 19-23, 2004 in San Francisco.

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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