Research Spotlight: Epinephrine Use in the Treatment of Anaphylaxis in Infants and Toddlers

Michael Pistiner, MD, MMSc, a physician investigator in the Pediatric Allergy Group at Mass General for Children and an assistant professor of pediatrics at Harvard Medical School,  is lead author of a recent study in the Journal of Allergy and Clinical Immunology (In Practice), Factors Associated With Epinephrine Use in the Treatment of Anaphylaxis in Infants and Toddlers. Carlos Camargo, MD, MPH, DrPH, is senior author of the study. 

What Question Were You Investigating?

Timely treatment of anaphylaxis—a severe and potentially life-threatening allergic reaction—with epinephrine is critical. But undertreatment, especially in infants and toddlers, remains an unmet need.

We set out to identify factors associated with receiving epinephrine for the treatment of probable anaphylaxis.

What Methods Did You Use?

Asthma and Allergy Foundation of America administered a national online survey of primary caregivers of young children that experienced their most severe food-triggered allergic reaction when they were younger than three years old.

We explored the association between certain factors and whether they were treated with epinephrine in the community setting and/or the healthcare setting.

Download an Anaphylaxis Action Plan from the American Academy of Pediatrics. 

What Did You Find?

Of 264 probable anaphylaxis cases, 39% of infants (under 12 months) and 61% of toddlers (aged 12-35 months) received epinephrine at any time during the child’ most severe allergic reaction.

Epinephrine is more likely to be used in infants and toddlers with a previously diagnosed food allergy, as compared to those who were not diagnosed with a food allergy.

In those with a previously diagnosed food allergy, 89% of those provided with anaphylaxis action plans were given epinephrine at any time during the reaction (community or healthcare setting). By comparison, 50% of infants and toddlers that were previously diagnosed with a food allergy but who did not have an anaphylaxis action plan were given epinephrine.

The odds of being treated with epinephrine were five times greater when an anaphylaxis action plan was provided as compared to when it was not (odds adjusted for age and previous diagnosis).

What Are the Implications?

Epinephrine use at any time (including in health care settings) during probable anaphylaxis is more likely in infants and toddlers with a previously diagnosed food allergy than those without diagnosis.

The provision of an anaphylaxis action plan is also associated with increased epinephrine use during probable anaphylaxis in this population.

Our work provides data that supports the importance of early food allergy evaluation and the importance of providing an anaphylaxis action plan to the caregivers of infants and toddlers.

Paper Cited:

Pistiner, M., Mendez-Reyes, J. E., Eftekhari, S., Carver, M., Lieberman, J., Wang, J., & Camargo, C. A., Jr (2023). Factors Associated With Epinephrine Use in the Treatment of Anaphylaxis in Infants and Toddlers. The journal of allergy and clinical immunology. In practice, S2213-2198(23)01204-7. Advance online publication. https://doi.org/10.1016/j.jaip.2023.10.049

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. MGH is a founding member of the Mass General Brigham healthcare system.