Trends in pediatric emergency department visits for food-induced anaphylaxis

• Published in: Journal of allergy and clinical immunology Vol. 126; no. 2; pp. 385 - 388
• Main Authors: Rudders, Susan A., MD, Banerji, Aleena, MD, Vassallo, Milo F., MD, PhD, Clark, Sunday, MPH, ScD, Camargo, Carlos A., MD, DrPH
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.08.2010; Elsevier Limited
• Subjects: Allergies; Allergy and Immunology; Anaphylaxis - epidemiology; Anaphylaxis - etiology; Anaphylaxis - therapy; Child; Child, Preschool; Emergency Service, Hospital; Food - adverse effects; Food allergies; Food Hypersensitivity - epidemiology; Food Hypersensitivity - etiology; Food Hypersensitivity - therapy; Hospitals; Humans; Peanuts; United States > US
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2010.05.018

Overall, the percentage of anaphylaxis patients receiving epinephrine (pre-ED or ED) increased over time (40% to 59%, P = .01); however, epinephrine treatment specifically in the ED did not change significantly (Table I). [...]similar percentages of patients with anaphylaxis were prescribed epinephrine auto-injectors.  2001-2002 2003-2004 2005-2006 No. of total ED visits 104,385 99,921 104,245 No. of food-induced anaphylaxis visits 160 155 531 Rate per 10,000 total ED visits 15.3 15.5 28.7 Demographic characteristics (% [95% CI])    Age (y), mean (SE) 10.3 (2.0) 7.9 (1.1) 8.0 (0.7) Male sex 65 (52-78) 56 (42-70) 57 (49-65) Race/ethnicity    White 36 (23-49) 57 (44-71) 39 (30-47) Black 40 (26-54) 14 (7-22) 31 (23-39) Hispanic 6 (4-9) 3 (2-5) 10 (5-16) Asian 6 (0-13) 6 (0-14) 10 (5-14) Other race 11 (2-21) 19 (6-32) 10 (6-16) Medical history (% [95% CI])    Known allergy to offending allergen 37 (24-50) 41 (27-55) 47 (38-55) Known allergic problems    Prior allergic reactions to other sources 51 (35-67) 61 (47-76) 68 (58-77) Asthma 52 (36-67) 50 (34-65) 54 (43-64) Hay fever 21 (8-34) 25 (12-38) 26 (17-36) Eczema 20 (9-31) 22 (14-31) 46 (36-56) Hives 0 0 0 Angioedema 0 0 0 Patient owns epinephrine auto-injector 49 (34-64) 46 (31-61) 54 (45-63) Clinical presentation (% [95% CI])    Location of exposure    Home 66 (52-80) 70 (56-84) 66 (58-75) School/day care 7 (1-12) 7 (0-15) 13 (6-19) Work 5 (0-12) 4 (0-13) NC Restaurant 13 (0-25) 9 (0-18) 12 (6-18) Other 9 (2-17) 10 (4-16) 9 (4-14) Specific food triggering current reaction    Peanuts 17 (8-26) 23 (12-34) 22 (15-29) Tree nuts 30 (17-42) 23 (11-34) 17 (11-23) Seeds 4 (0-11) 5 (0-12) NC Fruits/vegetables 5 (0-10) 18 (6-30) 6 (2-11) Shellfish 11 (2-21) 5 (0-12) 5 (2-8) Fish 2 (0-3) NC 4 (0-9) Food additives NC 4 (0-11) NC Milk products 17 (5-28) 14 (5-23) 19 (11-26) Eggs 6 (0-13) NC 6 (3-9) Wheat 0 0 NC Other food[low *] 24 (10-37) 17 (7-27) 24 (17-32) Treatment and disposition (% [95% CI])    Treatment with epinephrine before arrival to ED 42 (27-57) 53 (37-69) 55 (45-64) Treatment with epinephrine in ED 19 (14-25) 20 (9-31) 24 (17-30) Treatment with epinephrine (pre-ED or ED) 40 (29-51) 52 (38-66) 59 (51-68) Prescription for self-injectable epinephrine on discharge 66 (51-81) 65 (51-79) 68 (60-77) Referral to an allergist on discharge 39 (25-53) 32 (21-43) 55 (47-64) Table I Demographic characteristics, medical history, and clinical presentation of children presenting to the ED with food-induced anaphylaxis NC, Noncalculable.