Introduction
Oral food challenge (OFC) is the gold standard for diagnosing food
allergies [1]. Some patients present with anaphylaxis and require
intramuscular (IM) adrenaline injections. Previous studies reported that
among pediatric patients with positive reactions during OFCs, 9–11%
needed adrenaline injection [2, 3]. Furthermore, a previous study
reported that 6% of reactions treated with adrenaline required
multiple IM adrenaline injections when the symptoms persisted [4].
While most patients with anaphylaxis recover after IM adrenaline
injection, patients requiring multiple doses are likely to require
continuous adrenaline infusion [5]. In the Japanese food allergy
guideline, the strategy is recommended is to be considered when response
to treatment is not enough [6]”. Other guidelines for anaphylaxis
recommend that only specialists use continuous adrenaline infusion
because of adverse effects due to inappropriate dosage [7, 8]. Since
patients who need continuous adrenaline infusion are limited, there are
no randomized controlled trials or systematic reviews available.
Recommendations for infusion doses are based on the physician’s
experience.
We conducted a case-series study in the pediatric department in the
Showa University Hospital. We aimed to analyze the patients who needed
continuous adrenaline infusion during OFCs and suggest appropriate
timing to start the therapy and the optimal dose.
Our hospital has provided OFCs with physicians and nurses trained in
emergency interventions based on the pediatric advanced life support
system. All medical equipment and infusion procedures were prepared
according to the patients’ body weights before commencing the OFCs. A
rapid response team consisting of medical emergency staff is arranged to
be on call in the case of life-threatening events. IM adrenaline
injection (0.01 mg/kg) was administered in accordance with the Japanese
food allergy guideline [6]. In cases of anaphylactic shock, or
symptoms requiring more than two doses of IM adrenaline, we immediately
followed venous administration. Patients who required continuous
adrenaline infusion were treated proactively if they showed severe
symptoms refractory to IM adrenaline injection more than three times
with appropriate support therapy, or if the effect of the medicine
continued to incompletely improve the symptoms.
This study was approved by the ethics committee of the Showa University
Hospital (approval number: 3486).