Emergency management of food allergy: systems perspective

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.

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.

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.