Epinephrine Use Correlates to More Severe Allergic Reactions

The use of epinephrine is tied to higher severity for allergic reactions during peanut oral food challenges (OFC) of pediatric patients.

A team, led by Harris Droghini, MD, Cincinnati Children’s Hospital Medical Center, assessed clinical responses during oral food challenges using a new severity grading system for acute allergic reactions (SGS-AR).

The data was presented during the American Academy of Allergy, Asthma & Immunology Annual Meeting (AAAAI) 2022.

Grading Severity

The new system was developed by allergists and emergency physicians using the Delphi consensus methodology and requires validation in a number of clinical settings and the highly granular data collected during oral food challenge allergic reactions to produce a score.

The investigators believe patients who require epinephrine have higher score, which therefore would be associated with more extensive post-reaction monitoring.

In the study, a pediatric resident reviewed the prospectively collected allergic signs and symptoms to calculate a score on a 1-5 scale, with 5 being the most severe. Overall, they tested the new scale in 66 pediatric patients between 6 months and 17 years, who received epinephrine during peanut oral food challenges.

The allergic reactions were graded in a control group of age, sex, and race matches undergoing peanut oral food challenges without the need for epinephrine.

Severe Reactions

The cohort of patients treated with epinephrine experienced grade 4 (7%), grade 3 (32%), and grade 2 (61%) reactions, while the control group experienced grade 3 (3%), grade 2 (53%), and grade 1 (44%) reactions.

A higher severity grade was associated with increased post-epinephrine monitoring time.

However, this was highly variable for grade 2 and 3 reactions.

In addition, participants suffering grade 4 reactions had increased emergency department transfers and hospital admissions.

“In this first application of the SGS-AR, outcomes of post-epinephrine monitoring time, disposition, and the use of epinephrine correlated with severity grade during OFC allergic reactions,” the authors wrote. “Next, we will retrospectively validate and assess reliability amongst reviewers of differing experience levels.”

In another abstract presented during AAAAI 2022, investigators found visits to allergists could reduce the total healthcare costs for patients with peanut allergies.

More AAAAI Data

The analysis shows patients with peanut allergies had higher National Drug Codes and ICD-10 codes who visited an allergist compared to those with peanut allergies who did not visit an allergist during both baseline and follow-up (all P <0.001).

In addition, individuals with peanut allergies with an allergist visit were prescribed epinephrine at a significantly higher rate than those with peanut allergies without an allergist visit (RR, 1.67; P <0.001).

The rates of epinephrine claims (69.9% vs 63.3%), mean epinephrine costs ($676 vs $493), and proportion with peanut anaphylaxis episodes (48.9% vs 20.7%) were all higher in the peanut allergy and allergist visit group (all P <0.001).

Similarly, the proportion of anaphylaxis episodes also was higher in the peanut allergy group, compared to the control group (53.1% vs 31.6%; P <0.001).

The study, “Use of the severity grading system for acute allergic reactions (SGS-AR) to evaluate allergic reactions during peanut oral food challenges in a pediatric allergy center,” was published online in the Journal of Allergy and Clinical Immunology.