There are many debates in the world of food allergy, but one of the most important is when to administer drugs in the case of accidental or suspected ingestion of a food allergen.
The Timing of An Allergic Reaction
The mean time to respiratory or cardiovascular arrest after the ingestion of a food to which a patient is allergic is 30 minutes (Pumphrey RS, Clinical and Experimental Allergy 2000; 30(8):1144-1150). There is very little time for one to act after even the mildest symptoms present. Still, there are children who recover spontaneously from initial symptoms such as itching of the back of the throat or nausea after eating food. Because of these diverse responses, the debate grows. Do we wait and see or treat immediately?
Benefit of Having An Auto-Injector On-Hand
The benefit of using injectable epinephrine for anaphylaxis far exceeds the risk. The administration should occur sooner rather than later because fatalities in anaphylaxis usually result from delayed or inadequate administration of epinephrine. Additionally, at least one school district, Washington State School District, unequivocally states that “If a student, known to have anaphylaxis, has exposure or suspected exposure to an allergen, epinephrine is to be given immediately and the EMS (911) system activated.”
Overcoming The Reluctance To Sound The Alarm
This same source acknowledges that this puts a difficult decision-making process upon those administering epinephrine to a student. They state: “There is a natural reluctance to wait to administer epinephrine until symptoms worsen and you are sure the student is experiencing an anaphylactic reaction. There is the same reluctance to call 911. Many fatalities occur because the epinephrine was not administered in a timely manner.”
Benefits Outweigh Side Effects
The potential side effects of administering epinephrine to a child (in the appropriate dose) are not serious, and comparing these side effects to saving a life tilts the benefit to administering the drug. This may seem aggressive, but it is ultimately the safest approach.
Alternatives to Epinephrine Injectables
Alternative treatments – such as antihistamines, sublingual isoproterenol, inhaled epinephrine, and corticosteroids without epinephrine – may fail to prevent or relieve severe anaphylactic reactions. They are not first-line treatment for even suspected or potential anaphylaxis.