PERSONAL PRACTICE Management of anaphylactic reactions to food

A 12 year old boy with eczema, asthma, and severe intolerance to cows' milk protein ate a small amount of food which contained casein. He developed a severe anaphylactic reaction, and within minutes he was dead.' After recent publicity of similar cases in the press, this is a scenario now greatly feared by parents of children with food intolerance. This article addresses two controversial issues, the immediate treatment of anaphylactic reactions, and the role of adrenaline for home use. The terms anaphylaxis or anaphylactic shock are used in this context to mean a severe reaction of rapid onset, with circulatory collapse and hypotension. Some have used the term anaphylaxis to describe any immediate allergic reaction mediated by IgE antibodies, however mild, but such usage fails to distinguish between a trivial event (for example, a skin test reaction) and a life threatening one. Others use the terms local anaphylaxis and systemic anaphylaxis to describe respectively local reactions (for example, acute angioedema) and generalised reactions; we confine the term anaphylaxis to the latter.