Multicenter study of emergency department visits for food allergies

J Allergy Clin Immunol. 2004 Feb;113(2):347-52. doi: 10.1016/j.jaci.2003.10.053.


Background: Relatively little is known about the characteristics of patients who visit the emergency department (ED) for an acute allergic reaction. Although anaphylaxis guidelines suggest treatment with epinephrine, teaching about self-injectable epinephrine, and referral to an allergist, current ED management remains uncertain.

Objective: The objective of this study was to describe the management of food-related acute allergic reactions.

Methods: The Multicenter Airway Research Collaboration performed a chart review study in 21 North American EDs. Investigators reviewed a random sample of 678 charts of patients who presented with food allergy (International Classification of Diseases-ninth revision codes 693.1, 995.0, 995.3, and 995.60-995.69).

Results: Patients had an average age of 29 years; the cohort was 57% female and 40% white. A variety of foods provoked the allergic reaction, including nuts (21%), crustaceans (19%), fruit (12%), and fish (10%). Although exposure to these foods can be life threatening, only 18% of patients came to the ED by ambulance. In the ED, 72% of patients received antihistamines, 48% received systemic corticosteroids, and 16% received epinephrine; 33% received respiratory treatments such as inhaled albuterol. Among patients with severe reactions (55% of total), 24% received epinephrine. Overall, 97% of patients were discharged to home. At ED discharge, 16% of patients were prescribed self-injectable epinephrine, and 12% were referred to an allergist.

Conclusions: Although guidelines suggest specific approaches for the management of acute allergic reactions, ED concordance for food allergy appears low. These findings support a new collaboration between professional organizations in allergy and emergency medicine and the development of educational programs and materials for ED patients and staff.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anaphylaxis / diagnosis
  • Anaphylaxis / etiology
  • Anaphylaxis / therapy*
  • Cohort Studies
  • Emergencies*
  • Emergency Service, Hospital*
  • Epinephrine / therapeutic use
  • Female
  • Food Hypersensitivity / diagnosis
  • Food Hypersensitivity / etiology
  • Food Hypersensitivity / therapy*
  • Guideline Adherence
  • Humans
  • Male
  • Practice Guidelines as Topic / standards
  • Retrospective Studies


  • Epinephrine