Delay in EpiPen treatment fatal for food anaphylaxis in children, research shows

Research being presented at the Royal College of Emergency Medicine conference today (April 28) highlights the deadly delay in administering a life-saving adrenaline autoinjector (EpiPen) for food anaphylaxis, a severe and acute allergic reaction. Researchers are urging updated guidelines on the use of adrenaline treatments like EpiPens and hospital management of severe food anaphylaxis.

Fatal food anaphylaxis is rare but preventable. Hospital admissions due to food allergies in children have increased by 600% in the last two decades. A in 2024 Knife The study showed that rates of food allergies doubled between 2008 and 2018, with childhood cases increasing.

At this week’s conference, researchers from the University of Bristol and Bristol Children’s Hospital present findings from two Clinical and experimental allergy The study examined data from the National Childhood Mortality Database (NCMD) on fatal food-induced anaphylaxis in children. The research identifies key interventions that can help prevent future tragedies.

The first study examined the factors that contributed to the tragic deaths of 19 children from fatal food-induced anaphylaxis between 2019 and 2023. Key findings from both studies include:

• In 74% of cases, no adrenaline autoinjector (AAI), such as an EpiPen, or only one dose was given before cardiac arrest.
• Of the 19 children, 37% (7) did not have AAI, highlighting a major point of intervention and area for improvement with respect to this potentially life-saving drug.
• In 6 cases, the child or caregivers did not have any AAI, and in one case, only one AAI was available, preventing immediate administration of the second dose.
• The average time from symptom onset to cardiac arrest was 14 minutes in the 12 cases where data were available highlighting a shorter period of time.
• In all 19 cases, the child went into cardiac arrest before reaching the emergency department. Of these, 9 (47%) were 15 to 17 years old, 8 (42%) were 10 to 14 years old, and 2 (11%) were younger than 10 years old.

Previous research on deaths from asthma and anaphylaxis found that most fatal cases were food-borne and occurred at home, in public places or in schools, highlighting the need for better pre-hospital management to prevent child deaths. Recent work has also shown that anaphylaxis induced by different allergens affects physiological systems (airway, breathing or circulation) in different patterns. Fatal food anaphylaxis is more strongly associated with airway and breathing compromise.

in a second Clinical and experimental allergy In the study, the same research team analyzed the timeline of fatal food anaphylaxis events to identify lessons for improving their hospital management.
Analysis of 17 cases where the failing physiological system that led to death could be identified revealed that in all but one case, lung failure was the primary cause of death. This finding is important, as current NHS guidelines focus on heart and circulatory failure, suggesting that children arriving at hospital may not receive the most effective emergency treatment at the time they need it.
Dr Tom Roberts, NIHR Academic Clinical Lecturer in Emergency Medicine at the Bristol Medical School at the University of Bristol and A&E physician at North Bristol NHS Trust (NBT), and co-author of the research, explained: “Anaphylaxis caused by food allergy is a life-threatening emergency that requires immediate adrenaline, while EpiPens work rapidly to reverse symptoms by reducing inflammation and opening the airways.

“Our research shows that in many cases, children did not receive adequate adrenaline before cardiac arrest, and some did not have AAI at all. There is a very short window of time, often only a few minutes, in which appropriate treatment can potentially alter the clinical course of these events. Delays in giving adrenaline treatment, which can sometimes require more than one dose, can have fatal consequences.”

Our research also found that airway and breathing problems were the most common cause of food-related fatal anaphylaxis in children. While NHS guidelines currently focus on heart and circulatory failure in emergency management, our findings suggest that the focus should be on breathing problems, which was by far the most common cause of death in the cases we analysed. Circulatory problems without breathing problems were rare, indicating that updated guidelines should prioritize airway and breathing management in these serious situations.”

Dr John Coveney, lead author of the study from Bristol Children’s Hospital

Dr Ben McKenzie, an emergency medicine physician at the University of Melbourne and one of the lead authors of the Australian analysis presented here, who also tragically lost his 15-year-old son to food anaphylaxis, said: “This UK research confirms our Australian findings that fatal food anaphylaxis is driven by closure of the airways in the lungs. We need to promote the chain of survival in anaphylaxis – get help, give adrenaline and For healthcare workers – get oxygen into the body as a priority…”

Professor Karen Luyt, Program Director of the National Child Death Database and Professor of Neonatal Medicine at the University of Bristol, said: “The death of every child is a profound loss. By learning from each child’s death, we can identify where improvements are needed in systems, services and support to protect children’s lives.”