Anaphylaxis in a New York City pediatric emergency department: Triggers, treatments, and outcomes

• Published in: Journal of allergy and clinical immunology Vol. 129; no. 1; pp. 162 - 168.e3
• Main Authors: Huang, Faith, Chawla, Kanwaljit, Järvinen, Kirsi M., Nowak-Węgrzyn, Anna
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.01.2012; Elsevier; Elsevier Limited
• Subjects: Abdomen; Adolescent; Age; Allergic diseases; Allergies; Allergy and Immunology; anaphylaxis; Anaphylaxis - drug therapy; Anaphylaxis - epidemiology; Anaphylaxis - etiology; autoinjectable epinephrine; Biological and medical sciences; Child; Child, Preschool; Children; Digestive allergic diseases; Drug dosages; drugs; Emergency Service, Hospital; epinephrine; Epinephrine - administration & dosage; Epinephrine - therapeutic use; Female; Food; Food allergies; food allergy; Food Hypersensitivity - epidemiology; Food Hypersensitivity - etiology; food-induced anaphylaxis; foods; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Growth hormones; Histamine Antagonists - therapeutic use; Hospitalization; Hospitalization - statistics & numerical data; Humans; Immunopathology; Infant; infants; Male; males; Medical sciences; New York; New York City; Pain; patients; peanut allergy; pediatric emergency department; risk; risk reduction; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; seafood allergy; Severity of Illness Index; Shellfish; Steroids - therapeutic use; New York; United States; North America; America; New York City; United States > US; food-induced anaphylaxis; peanut allergy; ICD-9; autoinjectable epinephrine; seafood allergy; anaphylaxis; Children; food allergy; pediatric emergency department; PED; PICU; Pediatric intensive care unit; International Classification of Diseases-ninth revision; Food allergy; Pediatrics; Prognosis; Seafood; Anaphylaxis; Immunology; Emergency department; Evolution; Child; Food; Human; Epinephrine; Peanut; Immunopathology; Urban environment; food-irvduced anaphylaxis; Catecholamine; Treatment; Neurotransmitter; Digestive diseases
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2011.09.018

Anaphylaxis incidence is increasing. We sought to characterize anaphylaxis in children in an urban pediatric emergency department (PED). We performed a review of PED records for anaphylactic reactions over 5 years. We identified 213 anaphylactic reactions in 192 children (97 male patients): 6 were infants, 20 had multiple reactions, and the median age was 8 years (age range, 4 months to 18 years). Sixty-two reactions were coded as anaphylaxis; 151 additional reactions met the second symposium anaphylaxis criteria. There was no increase in incidence over 5 years. The triggers included the following: foods, 71%; unknown, 15%; drugs, 9%; and “other,” 5%. Food was more likely to be a trigger in multiple PED visits ( P = .03). Epinephrine was administered in 169 (79%) reactions; in 58 (27%) reactions epinephrine was administered before arrival in the PED. Patients with Medicaid were less likely to receive epinephrine before arrival in the PED ( P < .001). Twenty-eight (14.6%) patients were hospitalized, 9 in the intensive care unit. For 13 (6%) of the reactions, 2 doses of epinephrine were administered; 69% of the patients treated with 2 doses of epinephrine were hospitalized compared with 12% of the patients treated with a single dose ( P < .001). Administration of both epinephrine doses before arrival to the PED was associated with a lower rate of hospitalization compared with epinephrine administration in the PED ( P = .05). Food is the main anaphylaxis trigger in the urban PED, although the International Classification of Diseases-ninth revision code for anaphylaxis is underused. Treatment with 2 doses of epinephrine is associated with a higher risk of hospitalization; epinephrine treatment before arrival to the PED is associated with a decreased risk. Children with Medicaid are less likely to receive epinephrine before arrival in the PED.