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Emergency management of food allergy: systems perspective

Clark, Sundaya,b; Camargo, Carlos A Jra,b

Current Opinion in Allergy and Clinical Immunology: June 2005 - Volume 5 - Issue 3 - p 293–298
doi: 10.1097/01.all.0000168797.14487.73
Food allergy

Purpose of review Food-related allergic reactions are the leading cause of anaphylactic reactions treated in the emergency department, accounting for approximately 30 000 emergency department visits each year, and 150–200 deaths. The purpose of this review is to examine current research on food-related allergic reactions in the emergency department, and to provide suggestions for how to improve emergency department management.

Recent findings There are few published studies since March 2003 that examine the emergency management of food-related allergic reactions. Earlier studies found that few patients treated in the emergency department for this problem received health education (e.g., instructions to avoid offending food allergens), a prescription for self-injectable epinephrine, or referral to an allergy specialist at emergency department discharge. A recent multicenter study by our research group demonstrated that emergency department patients with food-related allergic reactions continue to receive care discordant from guidelines for the emergency management of allergic disorders and anaphylaxis. Discordance is low even among those with multisystem complaints consistent with anaphylaxis.

Summary Concordance with suggested guidelines for the treatment of severe acute allergic reactions remains poor. Development of a simple, clinical definition of food-related anaphylaxis is needed to improve emergency management. Dissemination of guidelines for the emergency management of anaphylaxis, and creation of systems to implement these guidelines, are essential for the improved treatment of food-related allergic reaction and anaphylaxis in the emergency department.

aDepartment of Epidemiology, Harvard School of Public Health

bDepartment of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

Funding: S C is supported by grant T32 ES07069 from the National Institute of Environmental Health Services (Research Triangle Park, NC, USA).

Correspondence to Sunday Clark, MPH, EMNet Coordinating Center, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA Tel: +1 617 724 0304; fax: +1 617 724 4050; e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.