Anaphylaxis Refractory to intra-muscular adrenaline during in-hospital food challenges: a case series and proposed management.
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
BACKGROUND: Anaphylaxis is a severe, systemic hypersensitivity reaction, that can be potentially life threatening. Anaphylaxis during oral food challenge is not uncommon and can usually be effectively managed with intramuscular adrenaline as first line treatment. Although very rare, fatal anaphylaxis during in-hospital food challenge has been reported. OBJECTIVE: We describe our experience of cases of refractory anaphylaxis at in-hospital challenge and propose a framework for escalation of treatment in such cases using intravenous infusion of adrenaline which has been adopted for widespread use elsewhere. METHODS: We present 4 patients who all experienced severe life-threatening anaphylaxis, refractory to intramuscular adrenaline treatment, during supervised oral food challenges. Patient data were collected from contemporaneous notes and patient consent was obtained. RESULTS: In all 4 cases, the anaphylaxis reactions were amenable to treatment with low dose intravenous adrenaline, with no reported adverse effects. CONCLUSION AND CLINICAL RELEVANCE: These cases demonstrate the need for clinicians undertaking higher risk allergen challenges to be able to manage cases of severe anaphylaxis refractory to intramuscular adrenaline, and to consider a framework for managing these reactions. Whilst peripheral intravenous adrenaline infusions should always be initiated only in conjunction with expert input, the protocol suggested is simple enough to be undertaken within the hospital environment while more experienced support is obtained.
Date Issued
2020-12
Date Acceptance
2020-09-19
Citation
Clinical and Experimental Allergy, 2020, 50 (12), pp.1400-1405
ISSN
0954-7894
Publisher
Wiley
Start Page
1400
End Page
1405
Journal / Book Title
Clinical and Experimental Allergy
Volume
50
Issue
12
Copyright Statement
© 2020 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
Medical Research Council (MRC)
National Institute for Health Research
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/32997857
Grant Number
MR/K010468/1
RDD02
Subjects
Allergy
adrenaline
anaphylaxis
food allergy
oral food challenge
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2020-09-30