• Johanna P M van der Valk, Irene Berends, Roy Gerth van Wijk, Nicolette J T Arends, Maurits S van Maaren, Hans de Groot, Harry J Wichers, Joyce A M Emons, DuboisAnthony E JAEJDepartment of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands., and Nicolette W de Jong.
• Department of Internal Medicine, Allergology, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: j.p.m.vandervalk@erasmusmc.nl.
• Ann. Allergy Asthma Immunol. 2018 Mar 1; 120 (3): 300-303.

BackgroundSevere allergic reactions, including anaphylaxis, occur during oral food challenges (OFCs) and the first-line treatment of anaphylaxis is epinephrine.ObjectiveTo evaluate the percentage of anaphylactic reactions treated with epinephrine during OFCs and to identify associated factors for the administration of epinephrine.MethodsChildren who underwent an OFC with peanut, hazelnut, cow's milk, hen's egg, or cashew nut from 2005 through 2015 in the Netherlands were evaluated. Children with reactions meeting the criteria for anaphylaxis according to the European Academy of Allergy and Clinical Immunology guidelines for food allergy and anaphylaxis were included. Children with an anaphylactic reaction treated with vs without epinephrine were compared. Possible factors associated with the administration of epinephrine, such as age, sex, symptoms consistent with asthma, history of an allergic reaction to the tested allergen, and symptom types during the anaphylactic reaction, were evaluated using logistic regression analysis.ResultsEighty-three children in clinical and research settings (43% boys; median age, 7 years; range, 1-17) who met the criteria for anaphylaxis were included in this study. Thirty-two of 83 children (39%) with anaphylaxis were treated with epinephrine. Respiratory symptoms during the OFC were treated significantly more often with epinephrine than gastrointestinal symptoms (P = .01).ConclusionOnly 39% of children with anaphylaxis, according to the guideline criteria, were treated with epinephrine during the OFC and most of these children had respiratory symptoms. There is need for an easy-to-use international guideline for the treatment of allergic symptoms during OFCs.Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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