Food Allergies: Are Two EpiPens Necessary?

Some authorities recommend that children with food allergies carry two doses of self-injectable epinephrine. To examine how often two doses are necessary, these authors performed a chart review of 1255 patients (median age, 5.8 years) who presented to two pediatric emergency departments (EDs) with food-related, acute allergic reactions. Anaphylaxis was defined as a reaction involving two or more organ systems or hypotension alone; 658 patients (52%) presented with anaphylaxis.

Home was the primary setting of exposure (70%), followed by school or day care (12%) and restaurants (9%). The most common triggers were peanuts (23%), tree nuts (18%), and milk (15%). Most patients (80%) presented within 3 hours of exposure. Only 3% of all patients an…