Sofianne Gabrielli1, Ann E Clarke2, Judy Morris3, Jocelyn Gravel4, Rodrick Lim5, Edmond S Chan6, Ran D Goldman7, Andrew O'Keefe8, Jennifer Gerdts9, Derek K Chu10, Julia Upton11, Elana Hochstadter12, Jocelyn Moisan13, Adam Bretholz14, Christine McCusker15, Xun Zhang16, Jennifer L P Protudjer17, Elissa M Abrams18, Elinor Simons18, Moshe Ben-Shoshan15. 1. Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. Electronic address: sofianne.gabrielli@mail.mcgill.ca. 2. Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 3. Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, QC, Canada. 4. Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada. 5. Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, ON, Canada. 6. Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada. 7. Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada. 8. Department of Pediatrics, Faculty of Medicine, Memorial University, St John's, NL, Canada. 9. Food Allergy Canada, Toronto, ON, Canada. 10. Division of Clinical Immunology and Allergy, Department of Medicine, and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 11. Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada. 12. Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. 13. Emergency Medical Services of Outaouais, Outaouais, QC, Canada. 14. Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada. 15. Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. 16. Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada. 17. Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada. 18. Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
Abstract
BACKGROUND: Data are sparse regarding the clinical characteristics and management of fruit-induced anaphylaxis. OBJECTIVE: To assess clinical characteristics and management of patients with fruit-induced anaphylaxis and determine factors associated with severe reactions and epinephrine use. METHODS: Over 9 years, children and adults presenting with anaphylaxis to seven emergency departments in four Canadian provinces and patients requiring emergency medical services in Outaouais, Quebec were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized form documenting symptoms, triggers, and management was collected. Multivariate logistic regression was used to identify factors associated with severe reactions and epinephrine treatment in the pre-hospital setting. RESULTS: We recruited 250 patients with fruit-induced anaphylaxis, median age 10.2 years (interquartile range, 3.6-23.4 years); 48.8% were male. The most common fruit triggers were kiwi (15.6%), banana (10.8%), and mango (9.2%). Twenty-three patients reported having eczema (9.3%). Epinephrine use was low in both the pre-hospital setting and the emergency department (28.4% and 40.8%, respectively). Severe reactions to fruit were more likely to occur in spring and among those with eczema (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI], 1.03-1.23; and 1.17, 95% CI, 1.03-1.34, respectively). Patients with moderate and severe reactions (aOR = 1.23; 95% CI, 1.06-1.43) and those with a known food allergy (aOR = 1.38; 95% CI, 1.24-1.54) were more likely to be treated with epinephrine in the pre-hospital setting. CONCLUSIONS: Severe anaphylaxis to fruit is more frequent in spring. Cross-reactivity to pollens is a potential explanation that should be evaluated further.
BACKGROUND: Data are sparse regarding the clinical characteristics and management of fruit-induced anaphylaxis. OBJECTIVE: To assess clinical characteristics and management of patients with fruit-induced anaphylaxis and determine factors associated with severe reactions and epinephrine use. METHODS: Over 9 years, children and adults presenting with anaphylaxis to seven emergency departments in four Canadian provinces and patients requiring emergency medical services in Outaouais, Quebec were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized form documenting symptoms, triggers, and management was collected. Multivariate logistic regression was used to identify factors associated with severe reactions and epinephrine treatment in the pre-hospital setting. RESULTS: We recruited 250 patients with fruit-induced anaphylaxis, median age 10.2 years (interquartile range, 3.6-23.4 years); 48.8% were male. The most common fruit triggers were kiwi (15.6%), banana (10.8%), and mango (9.2%). Twenty-three patients reported having eczema (9.3%). Epinephrine use was low in both the pre-hospital setting and the emergency department (28.4% and 40.8%, respectively). Severe reactions to fruit were more likely to occur in spring and among those with eczema (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI], 1.03-1.23; and 1.17, 95% CI, 1.03-1.34, respectively). Patients with moderate and severe reactions (aOR = 1.23; 95% CI, 1.06-1.43) and those with a known food allergy (aOR = 1.38; 95% CI, 1.24-1.54) were more likely to be treated with epinephrine in the pre-hospital setting. CONCLUSIONS: Severe anaphylaxis to fruit is more frequent in spring. Cross-reactivity to pollens is a potential explanation that should be evaluated further.
Authors: Paul J Turner; Stefania Arasi; Barbara Ballmer-Weber; Alessia Baseggio Conrado; Antoine Deschildre; Jennifer Gerdts; Susanne Halken; Antonella Muraro; Nandinee Patel; Ronald Van Ree; Debra de Silva; Margitta Worm; Torsten Zuberbier; Graham Roberts Journal: Allergy Date: 2022-04-28 Impact factor: 14.710