Epinephrine auto-injector for anaphylaxis in food allergic patients
Food allergy is one of leading causes of anaphylaxis. Currently there is no treatment for food allergy. It is therefore important that patients and health-care providers are capable of recognizing a severe food-allergic reaction and treating it adequately. The prevalence of food allergy in Dutch high-risk food-allergic adolescents has not increased appreciably in the last six years. The calculated questionnaire-based prevalence of probable food allergy was 6.2%.
All food-allergic patients at high risk of anaphylaxis should carry an epinephrine auto-injector (EAI) at all times. In the last six years the number of high-risk food-allergic patients having an EAI has improved marginally, as there is still a substantial under prescription of EAIs in the Netherlands. The under prescription of EAIs may be partly due to general practitioners not prescribing this medication to patients for whom it would be appropriate. Even when these patients, adolescents in particular, have been prescribed an EAI, they do not always carry their EAI, and often do not use it in the event of emergency situations.
Successful treatment of anaphylaxis in the community relies on early and correct use of EAIs. In the Netherlands, pharmacists supply EAIs to food-allergic patients and have a crucial role in instructing patients in how and when to use it. However, patients who received an EAI from a Dutch pharmacy were often not, or incorrectly instructed on its use.
Food allergy, anaphylaxis, and having to carry an EAI at all times, has a significant impact on quality-of-life of patients. Important predictors for adults were self-perceived disease, type of allergenic food, type of symptoms, and gender. For children these factors were type of allergenic food and country of origin. Surprisingly, experiencing anaphylaxis or being prescribed an EAI did not seem to be related to quality-of-life of either food allergic adults or children.
The time during which children are observed following a double-blind, placebo-controlled food challenge (DBPCFC) varies in clinical practice. Recommendations vary from between 2 to 24 hours. We showed that late reactions in food allergic children and adolescents after DBPCFC do occur, are poorly predictable, and are generally not severe. In our study no severe late reactions were reported. Therefore, it is probably not necessary to observe food allergic children for more than two hours after DBPCFC except following exceptionally severe immediate reactions.