Volume 6 Supplement 3

Fifth Annual Research Conference: Innovation from Cell to Society

Open Access

Treatment of allergic reactions to peanut in recent versus initial reaction

  • Moshe Ben-Shoshan1,
  • Luu Nha Nguyen2,
  • Reza Alizadehfar1,
  • Lianne Soller2,
  • Joe Fragapane2,
  • Lawrence Joseph2, 3,
  • Yvan St Pierre2,
  • Laurie Harada4,
  • Carole Fortin5,
  • Mary Allen6 and
  • Ann Clarke2, 7
Allergy, Asthma & Clinical Immunology20106(Suppl 3):P29

DOI: 10.1186/1710-1492-6-S3-P29

Published: 26 November 2010

Background

Although studies suggest underuse of epinephrine in food related allergic reactions, it is not clear whether treatment may differ over time in those who have already had an allergic reaction. We sought to characterize treatment of the most recent allergic reaction to peanut versus the initial allergic reaction.

Materials and methods

Individuals with an allergist-confirmed peanut allergy were recruited from the Montreal Children's Hospital and Canadian food allergy advocacy organizations. Data were collected on initial allergic reactions to peanut and most recent reaction to peanut during the year prior to study entry.

Results

See Table 1

Table 1

 

Epinephrine +/- other medications

Other medications (excluding epinephrine) eg: antihistamines

None

Initial reactions, % (95% CI)

8.9% (5.2, 14)

35.6% (28.6, 43)

55.6% (48, 62.9)

Mild

0.0% (0, 6.4)

28.6% (17.3, 42.2)

71.4% (57.8, 82.7)

Moderate

7.7% (3.1, 15.2)

37.4% (27.4, 48.1)

54.9% (44.2, 65.4)

Severe

27.3% (13.3, 45.5)

42.4% (25.5, 60.8)

30.3% (15.6, 48.7)

Treated only outside HCF

0.0% (0, 9.3)

100.0% (90.7, 100)

 

Treated only in HCF

44.8% (26.4, 64.3)

55.2% (35.7, 73.6)

 

Treated outside and in HCF

40% (5.3, 85.3)

60% (14.7, 94.7)

 

Location unknown

12.5% (0.3, 52.7)

87.5% (47.3, 99.7)

 

Most recent reactions % (95% CI)

17.2% (12, 23.5)

62.2% (54.7, 69.3)

20.6% (14.9, 27.2)

Mild

5.7% (1.2, 15.7)

64.2% (49.8, 76.9)

30.2% (18.3, 44.3)

Moderate

16.5% (9.7, 25.4)

63.9% (53.5, 73.4)

19.6% (12.2, 28.9)

Severe

40% (22.7, 59.4)

53.3% (34.3, 71.7)

6.7% (0.8, 22.1)

Treated only outside HCF

8.8% (3.9, 16.6)

91.2% (83.4, 96.1)

 

Treated only in HCF

20% (2.5, 55.6)

80% (44.4, 97.5)

 

Treated outside and in HCF

64% (42.5, 82)

36% (18, 57.5)

 

Location unknown

29.4% (10.3, 56)

70.6% (44, 89.7)

 

CI, Confidence interval; HCF, Health Care facility

Among 180 individuals reporting both an initial allergic reaction and a recent allergic reaction to peanut, epinephrine was administered in 8.9% (95% CI, 5.2-14.0%) and 17.2% (95% CI, 12.0-23.5%) respectively. Treatments excluding epinephrine were given in 35.6% (95% CI, 28.6-43.0%) of initial reactions and in 62.2% (95% CI, 54.7-69.3%) of most recent reactions. Among those treated only outside health care facilities (HCFs) no participant received epinephrine in initial reactions versus almost 9% (95% CI, 3.9-16.6%) in most recent reactions. However, in initial reactions, 44.8% (95% CI, 26.4-64.3%) of those treated, only in HCFs received epinephrine compared to 20% (95% CI, 2.5-55.6%) in recent reactions. Almost 1/3(95% CI, 15.6-48.7%) of participants with a severe reaction did not receive any treatment for the initial reaction compared to 6.7% (95% CI, 0.8-22.1%) of those with a recent reaction.

Conclusions

Although there is higher use of epinephrine in recent reactions compared to initial reactions, it is still administered in only 40% of severe allergic reactions. Further, our results suggest decreased epinephrine use over time in those treated initially in HCFs concurrent with increased use of other treatments such as anti-histamines. Given that prompt administration of epinephrine is the principal therapy for food-related anaphylaxis, it is crucial to develop and distribute guidelines and education programs that would contribute to increase epinephrine use inside and outside HCFs.

Authors’ Affiliations

(1)
Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center
(2)
Division of Clinical Epidemiology, Department of Medicine, McGill University Health Center
(3)
Departments of Epidemiology and Biostatistics, McGill University
(4)
Anaphylaxis Canada (AC)
(5)
Association Québécoise des Allergies Alimentaires (AQAA)
(6)
Allergy/Asthma Information Association (AAIA)
(7)
Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center

Copyright

© Ben-Shoshan et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

Advertisement