More than 170 foods have been reported to cause IgE-mediated reactions.¹ More than 90% of allergic reactions in affected individuals involve eight types of foods: peanuts, tree nuts, fish, shellfish, cow’s milk, soy, eggs, and wheat.13 Although many children will eventually tolerate milk, egg, soy, and wheat, far fewer will outgrow true allergies to tree nuts and peanuts.¹

The symptoms of food allergy are variable and can affect multiple organ systems.¹ The onset of symptoms varies from a few seconds or minutes after contact with the allergen to several hours,¹⁴ but the majority of events occur within 2 hours of exposure.15 A pattern of biphasic anaphylaxis has also been described in which symptoms recur after the apparent resolution of the initial episode.^16,17 Unfortunately, the severity of allergic reactions to food cannot be accurately predicted by the severity of previous reactions, allergen-specific IgE levels, or the size of the wheal from skin prick tests.1 Coexistent asthma is the most commonly identified factor associated with the most severe allergic reactions to foods.¹ Indeed, children with coexisting food allergy and asthma may be more likely to experience anaphylactic reactions and be at higher risk of death.^11,13

Children who have a coexisting food allergy as well as asthma may be more likely to experience anaphylactic reactions and be at a higher risk of death.

Managing Anaphylaxis

Prompt recognition and management of the signs and symptoms of anaphylaxis are essential to managing it.¹⁶ Immediate interventions for patients experiencing anaphylaxis include assessment of airway and breathing, circulation, and level of consciousness; administration of intramuscular (IM) epinephrine; and placement of the patient in a supine position in order to slow the progression of hemodynamic compromise.¹⁶ IM epinephrine injection is first-line treatment in all cases of anaphylaxis,1,16,18 and along with the use of oxygen, is considered the most important therapeutic agent administered for anaphylaxis.¹⁶

The appropriate dose of IM epinephrine should be administered immediately at the onset of symptoms, even if the diagnosis is uncertain.^16,18 At a concentration of 1:1000, the recommended dose of epinephrine via auto-injector is 0.15 mg for patients weighing 10-25 kg and 0.3 mg for patients weighing > 25 kg.¹

Epinephrine may be administered every 5 to 15 minutes as necessary, and if symptoms progress or recur (ie, biphasic reaction), repeat epinephrine dosing is recommended over adjunctive treatments.^1,16

Although up to a third of patients require more than one dose,19 additional measures (eg, intravenous epine- phrine, volume replacement, vasopressors) may be needed in patients not responding to multiple doses.¹⁶