BACKGROUND: Anaphylaxis incidence is increasing. OBJECTIVE: We sought to characterize anaphylaxis in children in an urban pediatric emergency department (PED). METHODS: We performed a review of PED records for anaphylactic reactions over 5 years. RESULTS: 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). CONCLUSIONS: 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.
BACKGROUND:Anaphylaxis incidence is increasing. OBJECTIVE: We sought to characterize anaphylaxis in children in an urban pediatric emergency department (PED). METHODS: We performed a review of PED records for anaphylactic reactions over 5 years. RESULTS: 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). CONCLUSIONS: 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.
Authors: Susan A Rudders; Aleena Banerji; Milo F Vassallo; Sunday Clark; Carlos A Camargo Journal: J Allergy Clin Immunol Date: 2010-08 Impact factor: 10.793
Authors: M W Yocum; J H Butterfield; J S Klein; G W Volcheck; D R Schroeder; M D Silverstein Journal: J Allergy Clin Immunol Date: 1999-08 Impact factor: 10.793
Authors: Aleena Banerji; Susan A Rudders; Blanka Corel; Alisha P Garth; Sunday Clark; Carlos A Camargo Journal: Ann Allergy Asthma Immunol Date: 2011-01 Impact factor: 6.347
Authors: F Estelle R Simons; Ledit R F Ardusso; M Beatrice Bilò; Yehia M El-Gamal; Dennis K Ledford; Johannes Ring; Mario Sanchez-Borges; Gian Enrico Senna; Aziz Sheikh; Bernard Y Thong Journal: J Allergy Clin Immunol Date: 2011-03 Impact factor: 10.793
Authors: Joanna S Cohen; Chisom Agbim; Michael Hrdy; Mary E Mottla; Monika K Goyal; Kristen Breslin Journal: Allergy Asthma Proc Date: 2021-03-01 Impact factor: 2.587