Food Allergy Research & Education Survey Shows Inconsistencies in Treatment of Life-threatening Allergic Reactions

Share Article

The results of a new patient survey from Food Allergy Research & Education show that treatment of allergic reactions in the emergency setting can be inconsistent and unpredictable, reinforcing the need for improved education about anaphylaxis among patients and emergency medical staff.

Treatment of allergic reactions in the emergency setting can be inconsistent and unpredictable, according to the results of a new Food Allergy Research & Education (FARE) patient survey about experiences with emergency department (ED) and emergency medical services (EMS) for serious allergic reactions. These findings reinforce the need for improved education about anaphylaxis among both patients and emergency medical staff. Today, FARE is welcoming members of the emergency medicine community for the Emergency Management of Anaphylaxis Summit in Chicago, where attendees will discuss how to improve the process of treating anaphylaxis on the continuum of emergency care.

More than 2,800 individuals – parents/caregivers of children with food allergies or individuals with food allergies – in 45 states completed FARE’s online survey. The survey included questions about response times, discharge procedures and the usage of epinephrine, the first-line treatment for anaphylaxis. Anaphylaxis is a serious allergic reaction that can occur suddenly and is potentially life-threatening. Most reactions described in the responses occurred in the last five years.

“While we were encouraged to see favorable trends in the treatment of serious allergic reactions by ED and EMS staff, it is also clear that there is more work to be done to help ensure that anaphylaxis is properly evaluated and treated in the emergency setting,” said James R. Baker Jr., M.D., interim CEO of FARE. “Our survey also showed that discharge instructions regarding follow-up and epinephrine refills were inconsistent, which could have an impact on effective ongoing management of food allergies.”

Highlights of the survey findings include:

Treatment of Allergic Emergencies is Inconsistent
Survey results showed that patient experiences varied greatly in both EMS and ED settings. Answers throughout the survey showed patients experienced a wide variety of diagnostic and treatment approaches in response to anaphylactic reactions. Comments about EMS experiences varied widely, from complimentary (“supportive,” “fantastic”) to negative (“EMT told me next time to just Epi her myself and transport to ER myself, that it would be quicker and free them for ‘other emergencies.’”). Epinephrine is the first-line treatment for anaphylaxis, but at the ED, steroids were the most common medication given (69 percent), followed by antihistamines (66 percent), epinephrine (42 percent) and Albuterol (28 percent).

Discharge Protocols Are in Need of Improvement
ED intake procedures for allergic emergencies show quick processing, with the majority of patients (69 percent) seen immediately or within five minutes of arriving at the ED; however, discharge procedures demonstrate that the majority of patients are not receiving critical information needed for effective ongoing management of severe allergies. While 64 percent of respondents received advice to continue steroids/antihistamines upon discharge from the ED, only 36 percent were given a prescription for epinephrine, and less than a quarter of respondents (24 percent and 18 percent, respectively), were given information about food allergies or a referral to an allergist. When looking at only those patients who experienced first-time reactions, the numbers improved, but only slightly: 41 percent were given a prescription for epinephrine, 31 percent were given information about food allergies and 32 percent were given a referral to an allergist. Twenty-one percent of the broader group did not receive any of this information upon discharge.

Both Emergency Staff and Patients Could Benefit from Increased Education
Due to the swift and serious nature of anaphylaxis, which can become life-threatening within minutes, both patients and emergency personnel need a strong understanding of how to recognize symptoms and appropriately treat anaphylaxis. Of the survey respondents who called 911, less than half had already administered epinephrine before making the call. In addition, despite prevailing medical guidance that individuals who have had an allergic reaction be observed for at least four hours in case symptoms reoccur (a biphasic reaction), in about one-third of the cases, patients were kept in the ED for observation less than two hours. Many comments provided to FARE within the survey about the ED experience reiterate the need for further education. One respondent wrote, “ER doctor was unaware that symptoms could return after the injection we gave at home,” while another described her son being given Albuterol as a first-line treatment for a near-fatal second reaction in the ED.

Both patients and emergency medicine providers should be aware of the following recommendations when managing an allergic emergency:

  •     Epinephrine is the first-line treatment for anaphylaxis. If an individual is experiencing anaphylaxis, or anaphylaxis is suspected, an epinephrine auto-injector (if available) should be administered immediately and before any other medications.
  •     After the epinephrine is administered, 911 should be called and told that epinephrine has been given for a suspected anaphylactic reaction. The patient should be transported to the hospital via an ambulance in case additional treatment is required en route.
  •     Individuals who have experienced an anaphylactic reaction should be observed in the ED at least four hours in case of a biphasic reaction, in which symptoms return after initially subsiding post-treatment.

Tonight in Chicago, FARE experts will discuss the survey’s findings during the opening night of the summit, a three-day event attended by state EMS officials, emergency medical technicians, ambulance providers, emergency department physicians, researchers and industry representatives. Topics for the summit include recognition of anaphylaxis in the general public, EMS protocols and policy, EMS education and training, ED definition of anaphylaxis and recognition and treatment, and improving discharge and follow-up. A parent panel is also scheduled.

The summit was made possible by a sponsorship from Mylan Specialty.

Food Allergy Research & Education (FARE) works on behalf of the 15 million Americans with food allergies, including all those at risk for life-threatening anaphylaxis. This potentially deadly disease affects 1 in every 13 children in the U.S. – or roughly two in every classroom. FARE’s mission is to find a cure for food allergies, and to keep individuals safe and included. We do this by investing in world-class research that advances treatment and understanding of the disease, providing evidence-based education and resources, undertaking advocacy at all levels of government and increasing awareness of food allergy as a serious public health issue. For more information, please visit

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Visit website