Factors Associated With Epinephrine Use in the Treatment of Anaphylaxis in Infants and Toddlers

The treatment of anaphylaxis is expeditious epinephrine administration. Undertreatment with epinephrine is common in young children. The present study sought to identify barriers and solutions to prompt administration of epinephrine.The Asthma and Allergy Foundation of America conducted an online survey of caregivers of patients who experienced a food-induced allergic reaction when they were younger than 36 months. Eligibility criteria included physician-diagnosed food allergy. Of 700 respondents, 374 caregivers completed the survey, and 264 patients were characterized as having experienced “probable anaphylaxis.” Probable anaphylaxis was defined by symptoms involving at least 2 of 5 organ systems (skin, respiratory, cardiovascular, gastrointestinal, and neurologic), with at least 1 being respiratory or cardiovascular.In this descriptive study, cases of probable anaphylaxis were grouped by epinephrine utilization. A subanalysis was conducted in patients with a previous food allergy diagnosis, grouped by epinephrine specifically administered by a nonhealthcare provider.Of 264 probable anaphylaxis cases, 39% of infants < 12 months and 61% of toddlers between 12 and 35 months received epinephrine during their most severe reaction. Children who received epinephrine were on average 5 months older than children who did not receive epinephrine. Forty percent of infants and 60% of toddlers experiencing probable anaphylaxis received epinephrine. Tree nuts and wheat were commonly identified as trigger foods among patients who received epinephrine, whereas peanut was commonly identified as the suspected trigger in patients who did not. Epinephrine was used in 89% of those with an anaphylaxis action plan, compared with 50% of those without. The adjusted odds ratio for the association between having an anaphylaxis action plan and epinephrine use was 5.39.Epinephrine use during probable anaphylaxis was more likely in infants and toddlers with previously diagnosed food allergy than those without a previous diagnosis. An anaphylaxis action plan was associated with increased epinephrine use.Recognition of anaphylaxis in young children may be more challenging than in older children and adults, as signs may be difficult to recognize and interpret. The marked difference in epinephrine use in patients who had an anaphylaxis action plan in the present study underscores the importance of educating caregivers, and further underscores the need to equip caregivers with both epinephrine and an anaphylaxis action plan.