By Gina Mennett Lee, M.Ed.

President & Founder, Food Allergy Education Network

Statistics indicate that in the United States we woefully underuse epinephrine to treat allergic reactions.  In fact, in a journal of Pediatrics article from February 2012, it was found that epinephrine was administered in only 29.9% of severe reactions of preschool-aged children.

The debate about when to use epinephrine has been a constant one in the food allergy community, but it was further fueled by the tragic loss of Natalie Giorgi to anaphylaxis over the summer   Her story was especially difficult due to the fact that the parents seemed to have acted in accordance with her Food Allergy Action Plan.   After a known ingestion, they gave her antihistamine and observed her for signs of an allergic reaction.  Unfortunately, by the time there were visible signs, Natalie’s reaction could not be halted even with 3 doses of epinephrine.  This made me and others in the food allergy community start to really question our approach to allergic reactions in this country.

Jennifer Van Evra of Allergic Living conducted an excellent interview on the topic here.  What struck me most while reading this article was one particular quote from Dr. Susan Waserman, “We [Canadian allergists] propose that epinephrine be given, at the first sign of any reaction.”   This means that in Canada they recommend the use of epinephrine at any sign, even if it is “only hives” or “only localized”.  What a dramatically different approach!  Could we in the United States, be preventing  unnecessary deaths by adopting this approach?  It certainly would make the decision-making process easier for those who care for children with food allergies.   There is much apprehension on the part of parents, caregivers, teachers, and school nurses when it comes to the question of when to use epinephrine.

Let’s take a look at two different food allergy action plans.

This one is from FARE and used in the United States.  On this action plan, there are two sets of instructions, one for “mild symptoms” and another for “severe symptoms”.

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This one is from Anaphylaxis Canada and used in Canada.  Here there is only one set of instructions ( as seen in the third section).  “Act quickly.  The first signs of an allergic reaction can be mild, but symptoms can get worse very quickly.  1. Give epinephrine…2. Call 9-1-1…”

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Imagine being a parent, caregiver, teacher, or nurse reading these food allergy action plans.

Which one do you think it easier to understand and to follow?  Which one leaves less uncertainty about when to use epinephrine?  To me the answer is very clear.  Are there any drawbacks to this more aggressive approach?

I think it may be time for the medical community in the United States to take a hard look at this and rethink their approach.  Consistent and clear instructions about when to use epinephrine truly are needed in order to ensure that those with food allergies will receive the proper emergency treatment.

What do you think?

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