Use of multiple doses of adrenaline for food-induced anaphylaxis

Background: The aim of this study was to determine the rate, characteristics, and risk factors in patients who required multiple doses of adrenaline for treatment of anaphylaxis. Methods: We retrospectively reviewed the positive oral food challenges (OFCs) with anaphylaxis in pediatric patients at Saitama City Hospital between January 2013 and November 2014, analyzing age, sex, comorbid allergic disease, specific IgE level, food, symptoms, and treatment. Result: There were 42 positive challenges with anaphylaxis, and the median age of the patients was 4 years old. Eighteen patients were treated with adrenaline, 5 of whom (11.9% of anaphylaxis cases) were administered multiple doses of adrenaline. Among the 5 patients, 3 were treated with infusion. We compared patients who were not administered adrenaline or were administered a single dose of adrenaline with those who were administered multiple doses of adrenaline. No significant differences were found among the groups in relation to age, sex, comorbid allergic disease, and the aim of OFCs. The number of patients who received multiple doses of adrenaline treatment was more in the milk OFCs than the other foods OFCs. Cardiovascular and neurological symptoms were more severe in patients who received multiple doses of adrenaline. Conclusion: Information that multiple doses of adrenaline may be required at the time of anaphylaxis should be widely disseminated.