Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Allergy Unit

Student research

Management of children with food-induced anaphylaxis

Debbie Cohen
Master of Nutrition and Dietetics, The University of Sydney
Supervisors: Velencia Soutter, Robert Loblay, Anne Swain
June 1999

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Food-induced anaphylaxis is the most severe form of food allergy. It consists of a complex of symptoms which can be fatal if prompt emergency treatment is not given. Since there is no known cure, management involves strict avoidance of known food allergens and prompt emergency action when there has been inadvertent exposure to the offending food. Injectable adrenaline is the drug of choice for anaphylaxis, however its prescription can complicate the management of at-risk children and may contribute to parental anxiety. There is little informaion available regarding the circumstances surrounding episodes of food-induced anaphylaxis or the impact this condition has on the lives of patients and their families.

To investigate a range of issues regarding the management of children at risk of food-induced anaphylaxis.

The population surveyed in this study were children who had been identified as being at risk of food-induced anaphylaxis. Data was collected using a written questionnaire, which explored various aspects in the management of children with food-induced anaphylaxis and recorded the circumstances surrounding previous anaphylactic reactions, such as location, food triggers and emergency treatment.

Three hundred and three episodes of anaphylaxis occurred in 164 children. Almost half of those surveyed had experienced multiple reactions often to different foods. Peanut, egg and cow's milk were the most common food triggers and the majority of reactions occurred in the child's own home. Administration of adrenaline once a reaction had occurred was infrequent. While most schools had an emergency action plan for dealing with episodes of accidental exposure, several respondents had encountered problems with the school system, especially in relation to the administration of adrenaline. Nutritional concerns of parents and the social impact of food-induced anaphylaxis on patients and their families were also investigated.

Children with an identified food allergy should undergo skin prick tests for a range of other foods wich could potentially cause anaphylaxis. In addition, all carers of at-risk children should be educated regarding the prevention and management of anaphylaxis, including the use of injectable adrenaline. A training package for schools would be useful to reduce anxiety amongst school personnel and to help ensure the safety of children at risk of anaphylaxis while at school.