Nearly all patients who required multiple doses of epinephrine also suffered from asthma.

Many children and adults at risk of severe allergic reactions are currently advised to carry only a single epinephrine auto-injector, which is administered when a severe reaction occurs.

In her study article, lead author Kirsi M. Järvinen, MD, PhD, writes that “the recommendation to carry two doses of epinephrine should as minimum be extended to individuals with asthma and significant food allergies.” 

Järvinen and colleagues from Mount Sinai School of Medicine studied the histories of 413 food-allergic children. They identified 78 patients who had received epinephrine to treat a total of 95 anaphylactic reactions. Parents of the children were asked to recall the suspected food trigger, how rapidly symptoms developed and the timing of treatment.

Of the 95 reactions treated with epinephrine, a second dose of the medication was administered in 19 percent of cases (18 patients). A third dose was required in 6 percent of cases (6 cases). 

Of those who received multiple doses, all but one (94 percent) were also diagnosed with asthma.

In a surprise finding, the survey results also indicated that many children did not receive epinephrine, despite past severe reactions. While 51 percent of total patients studied reported a past history of anaphylactic symptoms, only 20 percent had ever used epinephrine.  

Anaphylaxis is a serious, potentially life-threatening allergic reaction that can affect the cardiovascular, respiratory or gastrointestinal systems of the body. An estimated 100-150 people in the United States die each year from anaphylaxis, according to the American Academy of Allergy, Asthma & Immunology (AAAAI). Anaphylaxis is most commonly caused by allergic reactions to food, insect stings and medication.

Food allergies affect 3 million American children, including 1 in 17 children under the age of 3, according to the AAAAI. Additionally, about 9million children in the United States have asthma. 

The Journal of Allergy and Clinical Immunology is the official scientific journal of the AAAAI.

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. The AAAAI is the largest professional medical organization dedicated to the allergy/immunology specialty. Established in 1943, the AAAAI has nearly 6,500 members in the United State, Canada and 60 other countries.