Should epinephrine be injected to all children with food allergy: 'cons'

Allergic emergencies are increasing. The principal aetiology in children is food allergy. Epinephrine is the first treatment for anaphylaxis. It is th e subject of the recent review. However, prescribing epinephrine in all foo d allergies is discussed. It is of no use to prescribe epinephrine without accurate diagnosis, an educational programme, information and follow-up. Th e prescription of epinephrine is associated with parental distress and prob lems at school and in the canteen. Finally, educational programmes are more effective than epinephrine prescription. Before prescribing epinephrine, w e have to define the situations where there is a risk of anaphylaxis. We ha ve to improve knowledge of epinephrine use: dose, site of injection, route, expiration dates and availability when necessary. Because most allergic re actions occur at restaurants or outside the home, why prescribe epinephrine if the auto-injector stays at home or in the refrigerator? We have to impr ove the treatment of anaphylaxis with use of epinephrine in first aid befor e prescribing epinephrine in all food allergies that are not identical. (C) 2001 Editions scientifiques et medicales Elsevier SAS.