Events Reported to a 24 Hour Helpline for Food Allergic Reaction Treatment Advice in Children Prescribed Epinephrine Auto-Injectors: Randomised Controlled Trial

Rationale Children at risk of anaphylaxis to food are prescribed epinephrine auto-injectors. Uncertainty over when to use these can lead to anxiety. Treatment delay may worsen outcomes of allergic reactions. We hypothesised that access to expert advice may assist carers to treat food allergic reactions in the community more appropriately. Methods 52 children (< 16 years) with food allergy, trained in epinephrine auto-injector use, were recruited from a hospital-based paediatric allergy clinic. The intervention group was randomised to receiving the helpline number to call in the event of suspected anaphylaxis to food. This helpline was staffed by paediatric allergy, medical and nursing specialists for a 6 month period. Results 3 calls were received from 25 subjects in the intervention group, 2 involving the same child. Of the 3 foods implicated 2 were new foods, both kiwi, neither previously safely ingested nor screened for in clinic. Each call related to minor reactions. Epinephrine use was not advised. There were 5 other unreported minor reactions in the intervention group. 5 of 27 children in the control group reported minor allergic reactions. 4 were treated with antihistamine only. One parent used epinephrine for a reaction which, in retrospect, would not have met our criteria for its use. Conclusions No child experienced a serious allergic reaction. One epinephrine use in the control group could potentially have been prevented. However 24-hr access to specialist advice may have encouraged 2 families to take a risk on foods they did not know were safe for their child.