Food Allergy in Practice: Optimizing the Management of Anaphylaxis

Food allergy induced anaphylaxis is a serious and life-threatening allergic reaction that can occur across the lifespan, requiring rapid recognition and immediate treatment to prevent mortality. Although intramuscular epinephrine remains the cornerstone of anaphylaxis management, underuse and delayed administration persist due to fear of injections, accessibility and adherence, and gaps in education. Recent updates to anaphylaxis practice parameters have reinforced the importance of early epinephrine administration, individualized emergency response planning, and shared decision making, while the therapeutic landscape has evolved with the introduction of novel epinephrine delivery systems designed to address barriers associated with traditional intramuscular autoinjectors. These newer options, including intranasal epinephrine, offer additional choices for patients and caregivers but require clinicians to understand their pharmacologic profiles, appropriate patient selection, efficacy and safety data, and implications for adherence and real-world use. As treatment options expand, healthcare professionals must be equipped to tailor management strategies to the needs of infants, children, adolescents, and adults at risk for anaphylaxis. This Interactive Case Consult features Anna Nowak-Wegrzyn, MD, PhD, Professor of Pediatrics at NYU Grossman School of Medicine and Director of the Pediatric Allergy and Immunology Division at Hassenfeld Children s Hospital, NYU Langone Health, and Manish Ramesh, MD, PhD, Chief of the Division of Allergy and Immunology at Montefiore Medical Center, Albert Einstein College of Medicine, as they explore case-based approaches to applying updated guideline recommendations and selecting among current and emerging epinephrine delivery options to improve preparedness, adherence, and outcomes.