From the Guidelines
Health care spending on pediatric anaphylaxis has indeed increased dramatically over the past decade, primarily due to the rising prevalence of food allergies and the increasing cost of epinephrine auto-injectors. The cost surge is driven by several factors, including the rising price of epinephrine auto-injectors, such as EpiPen, which has seen significant price increases, sometimes exceeding 500% over the past decade 1.
Key Factors Contributing to Increased Spending
- Increasing prevalence of food allergies among children, with peanut, tree nut, milk, egg, and shellfish allergies being the most common triggers
- Rising price of epinephrine auto-injectors
- Increased emergency department visits and hospitalizations for severe reactions
- Growing need for specialist allergy care
- Preventive management, including allergen avoidance education and the prescription of multiple auto-injectors for different settings
Standard Treatment for Anaphylaxis
Standard treatment for anaphylaxis requires immediate administration of epinephrine (0.01 mg/kg, maximum 0.3 mg for children and 0.5 mg for adolescents) via intramuscular injection in the mid-outer thigh, with the potential need for a second dose after 5-15 minutes if symptoms persist 1.
Economic Burden
The economic burden extends beyond direct medical costs to include indirect costs such as lost school days, parental work absences, and the psychological impact on families managing this potentially life-threatening condition 1.
Recent Guidelines
Recent guidelines, such as the 2024 American Heart Association and American Red Cross guidelines for first aid, emphasize the importance of prompt epinephrine administration in the treatment of anaphylaxis 1.
Conclusion Not Applicable
Instead, the focus should be on prioritizing the most recent and highest-quality evidence, such as the 2024 guidelines, to inform treatment decisions and reduce the economic burden of pediatric anaphylaxis 1.
From the Research
Health Care Spending on Pediatric Anaphylaxis
- The increase in health care spending on pediatric anaphylaxis can be attributed to various factors, including the rising incidence of anaphylaxis in children 2.
- According to the European Anaphylaxis Registry, food is the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk, and nuts 2.
- The management of anaphylaxis in children is a complex issue, with controversies surrounding adjuvant therapies, biphasic reactions, observation times, and disposition of patients 3.
Management of Anaphylaxis in Children
- Early recognition of anaphylaxis and administration of epinephrine are crucial in the management of anaphylaxis in children 3, 4.
- The use of epinephrine auto-injectors and prevention of recurrences are essential components of long-term management of pediatric anaphylaxis 4.
- Antihistamines and corticosteroids may also be used in the management of anaphylaxis, but their role is not well established 5, 6.
Epidemiology and Risk Factors
- The incidence of anaphylaxis is on the rise, with food-induced anaphylaxis hospitalizations increasing among children in the US 2.
- Fatalities due to anaphylaxis are rare, but potential risk factors for fatalities include delayed epinephrine administration and lack of vigilance among patients, caregivers, and healthcare professionals 4, 2.
- Strict avoidance of the allergen and optimal management of existing co-morbidities are essential in preventing anaphylaxis in children 2.
Treatment and Education
- Patients and their families need to be well educated on how to manage potential anaphylactic reactions, including the use of adrenaline auto-injectors and personalized emergency management plans 4, 2.
- Healthcare professionals must be familiar with the clinical emergency of anaphylaxis and able to respond in a timely and appropriate manner 4, 2.
- The evidence base for the pharmacologic treatment of anaphylaxis is limited, and further research is needed to strengthen the evidence base for treatment and guide clinical decision-making 6.