Parents of children with severe food allergies should carry two EpiPens, not just one

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Parents of children with severe food allergies should always carry two EpiPens or similar devices because one shot of epinephrine is often not sufficient to overcome an allergic reaction, researchers reported Monday. At least one in every eight children suffering anaphylactic shock from a reaction to food required a second dose of the drug to fully recover, researchers from Children’s Hospital Boston reported in the journal Pediatrics.

Surprisingly, the researchers found, even children who went to the hospital for their symptoms were often not treated properly and were not given prescriptions for the devices on their discharge.

Food allergies affect at least 6% of children and, by most estimates, seem to be rising. Symptoms of a severe reaction include skin rash, itching, swelling, trouble swallowing and breathing, nausea and vomiting. An injection of epinephrine is often enough to reverse the condition, but sometimes two shots may be necessary, Dr. Susan A. Rudders of Children’s Hospital Boston said.

Rudders and her colleagues studied about 1,200 children with an average age of 6 who were treated at two Boston hospitals for food-related allergic reactions between 2001 and 2006. A little over half of the children suffered severe reactions and 44% of this group received epinephrine. Of that smaller group, 12% received two doses of epinephrine.

To the researchers’ surprise, half of the children with severe reactions did not get epinephrine even after going to the hospital. Instead, they received antihistamines, steroids, intravenous fluids and inhaled medicines -- none of which have been proved to be effective first-line treatments. Furthermore, fewer than half of the children left the hospital with a prescription for injectable epinephrine and only 22% were advised to see an allergist.

The most common offending foods included peanuts, tree nuts, milk, shellfish, fish and eggs. Some of the allergic reactions were also triggered by fruits and vegetables, however, even though they are generally considered to have a low propensity for causing allergic reactions.

-- Thomas H. Maugh II