Emergency treatment
First-line treatment was administered in 89% of peanut anaphylaxis and 91% of reactions triggered by other food.
24% of cases in the peanut subgroup and 27% in the other food subgroup were solely lay treated, mainly by a family member (80% vs 81%). Another 12% and 13% respectively were initially cared for by a lay person followed by a professional. 17% (n=28) of the peanut allergic children self-administered an adrenaline auto-injector (AAI), with a similar figure (n=78; 15%) for other food triggers. Lay treatment also included oral antihistamines (63% vs 79%; p<0.001), oral steroids (46% vs 50%) and beta2-agonist inhalers (35% vs 25%; p=0.008) (Table 2).
Emergency treatment was carried out solely by a healthcare professional in 52% of the peanut subgroup and 61% of the other food subgroup. 39% vs 44% were treated by an emergency physician, and 14% vs 11% by a general practitioner. Professional treatment included adrenaline (intramuscular (i.m.), intravenous (i.v.), and inhalative) (26% vs 34%; p=0.003), antihistamines (i.v. and oral) (68% vs 66%), corticosteroids (i.v., oral, and rectal) (74% vs 70%), or beta2-agonist (i.v., oral, and inhalative) (31% vs 25%; p=0.044) (Table 2).
Almost one in two peanut allergic children (44%) already prescribed an AAI did not use or carry the device. The percentage was slightly higher but not statistically significant for other food allergies (53%) (Table 2).
Second-line treatment (i.e. additional doses or other drugs not used for initial management, with failure of first-line treatment) was reported in 24% of peanut allergic children (n=93 out of 388 cases with this information available), with no significant difference compared to the other food subgroup (19%; n=248 out of 1279 cases with this information available). A second dose of adrenaline was administered in 5% (n=10) of peanut anaphylaxis and 6% (n=41) in the non-peanut food group (Table 2).
Hospitalisation was required in a higher number for peanut anaphylaxis compared to other food (67% of 280 cases with known hospitalisation status vs 54% of 998 cases, p=0.004), but there was no difference regarding admission to Intensive Care Unit (6% vs 5%) (Table 2).
Tryptase testing was performed outside the episode in 21% of cases in both subgroups. Elevated serum levels were only registered in a small percentage and with no statistically significant difference between the 2 subgroups (14% vs 6%).