Andrew O'Keefe1, Ann Clarke2, Yvan St Pierre3, Jennifer Mill3, Yuka Asai4, Harley Eisman5, Sebastien La Vieille6, Reza Alizadehfar3, Lawrence Joseph3, Judy Morris7, Jocelyn Gravel8, Moshe Ben-Shoshan9. 1. Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada. 2. Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada. 4. Division of Dermatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada. 5. Montreal Children's Hospital, Emergency Department, McGill University Health Centre, Montreal, Quebec, Canada. 6. Food Directorate, Health Canada, Ottawa, Ontario, Canada. 7. Department of Emergency Medicine, Sacré-Coeur Hospital, University of Montréal, Montreal, Quebec, Canada. 8. Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada. 9. Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
Abstract
OBJECTIVES: To determine the recurrence rate of anaphylaxis in children medically attended in an emergency department (ED), we performed a prospective cohort study to evaluate prehospital and ED management of children with recurrent anaphylaxis and to assess factors associated with recurrent anaphylaxis. STUDY DESIGN: As part of the Cross-Canada Anaphylaxis Registry, parents of children with anaphylaxis identified prospectively in 3 EDs and through an emergency medical response service were contacted annually after presentation and queried on subsequent reactions. Cox regression analysis determined factors associated with recurrence. RESULTS: Among 292 children who were registered as having had medical attended anaphylaxis, 68.5% completed annual follow-up questionnaires. Forty-seven patients experienced 65 episodes of anaphylaxis during 369 patient-years of follow-up. Food was the trigger in 84.6% of cases, and epinephrine was used in 66.2%. In 50.8%, epinephrine was used outside the health care facility, and 81.7% were brought to a health care facility for treatment. Asthma, reaction triggered by food, and use of epinephrine during the index episode increased the odds of recurrent reaction. Patients whose initial reaction was triggered by peanut were less likely to have a recurrent reaction. CONCLUSIONS: We report a yearly anaphylaxis recurrence rate of 17.6% in children. There is substantial underuse of epinephrine in cases of anaphylaxis. Educational programs that promote effective avoidance strategies and prompt use of epinephrine are required.
OBJECTIVES: To determine the recurrence rate of anaphylaxis in children medically attended in an emergency department (ED), we performed a prospective cohort study to evaluate prehospital and ED management of children with recurrent anaphylaxis and to assess factors associated with recurrent anaphylaxis. STUDY DESIGN: As part of the Cross-Canada Anaphylaxis Registry, parents of children with anaphylaxis identified prospectively in 3 EDs and through an emergency medical response service were contacted annually after presentation and queried on subsequent reactions. Cox regression analysis determined factors associated with recurrence. RESULTS: Among 292 children who were registered as having had medical attended anaphylaxis, 68.5% completed annual follow-up questionnaires. Forty-seven patients experienced 65 episodes of anaphylaxis during 369 patient-years of follow-up. Food was the trigger in 84.6% of cases, and epinephrine was used in 66.2%. In 50.8%, epinephrine was used outside the health care facility, and 81.7% were brought to a health care facility for treatment. Asthma, reaction triggered by food, and use of epinephrine during the index episode increased the odds of recurrent reaction. Patients whose initial reaction was triggered by peanut were less likely to have a recurrent reaction. CONCLUSIONS: We report a yearly anaphylaxis recurrence rate of 17.6% in children. There is substantial underuse of epinephrine in cases of anaphylaxis. Educational programs that promote effective avoidance strategies and prompt use of epinephrine are required.
Authors: Mélanie Leung; Ann E Clarke; Sofianne Gabrielli; Judy Morris; Jocelyn Gravel; Rodrick Lim; Edmond S Chan; Ran D Goldman; Paul Enarson; Andrew O'Keefe; Jennifer Gerdts; Derek Chu; Julia Upton; Xun Zhang; Greg Shand; Moshe Ben-Shoshan Journal: CMAJ Date: 2020-09-21 Impact factor: 8.262
Authors: Lacey B Robinson; Anna Chen Arroyo; Rebecca E Cash; Susan A Rudders; Carlos A Camargo Journal: Allergy Asthma Proc Date: 2021-05-01 Impact factor: 2.587
Authors: P Bégin; E S Chan; H Kim; M Wagner; M S Cellier; C Favron-Godbout; E M Abrams; M Ben-Shoshan; S B Cameron; S Carr; D Fischer; A Haynes; S Kapur; M N Primeau; J Upton; T K Vander Leek; M M Goetghebeur Journal: Allergy Asthma Clin Immunol Date: 2020-03-18 Impact factor: 3.406