Increasing visits for anaphylaxis and the benefits of early epinephrine administration: A 4-year study at a pediatric emergency department in Montreal, Canada

• Published in: Journal of allergy and clinical immunology Vol. 137; no. 6; pp. 1888 - 1890.e4
• Main Authors: Hochstadter, Elana, MD, Clarke, Ann, MD, MSc, De Schryver, Sarah, MD, LaVieille, Sebastien, MD, MSc, Alizadehfar, Reza, MD, Joseph, Lawrence, PhD, Eisman, Harley, MD, Ben-Shoshan, Moshe, MD, MSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2016; Elsevier Limited
• Subjects: Age; Allergy and Immunology; Anaphylaxis - drug therapy; Anaphylaxis - epidemiology; Asthma; Child; Child, Preschool; Eczema; Emergency Service, Hospital; Epinephrine - administration & dosage; Female; Food; Food allergies; Hospitals; Humans; Male; Pediatrics; Prospective Studies; Quebec; Retrospective Studies; Studies
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2016.02.016

In line with other studies, asthma and eczema were associated with a more severe reaction.8 An important observation in our study is that administration of epinephrine, before arrival in the ED, is independently associated with a decreased likelihood of requiring multiple doses of epinephrine in the ED, suggesting that prompt epinephrine administration is beneficial.\n7 (20.9-33.3) 57.8 (51.2-64.1) 49.9 (44.4-55.3) 47.2 (44.0-50.4) Asthma 22.3 (16.2-29.8) 18.6 (13.7-24.6) 17.4 (12.9-22.9) 18.8 (14.8-23.4) 19.0 (16.5-21.6) Eczema 17.8 (12.4-24.9) 13.3 (9.2-18.9) 13.6 (9.6-18.8) 20.2 (16.2-25.0) 16.6 (14.3-19.2) Table E1 Demographic characteristics and atopic comorbidities Trigger % (95% CI) Year 1 Year 2 Year 3 Year 4 All 4 years Food trigger 85.5 (79.1-90.3) 80.6 (74.6-85.6) 79.1 (73.3-83.9) 82.4 (77.9-86.2) 82.1 (79.5-84.4) Peanut 30.3 (23.0-38.6) 20.6 (15.0-27.5) 20.6 (15.2-27.2) 20.3 (15.8-25.6) 22.2 (19.4-25.3) Tree nut 15.5 (10.2-22.7) 14.8 (10.1-21.2) 13.8 (9.3-19.7) 18.1 (13.9-23.2) 13.4 (11-16) Milk 7.0 (3.6-12.9) 6.3 (3.3-11.3) 7.9 (4.7-13.0) 6.4 (3.9-10.1) 6.8 (5.2-8.9) Egg 5.6 (2.6-11.2) 7.4 (4.2-12.6) 6.9 (3.9-11.7) 4.3 (2.3-7.5) 5.8 (4.3-7.7) Sesame 2.8 (0.9-7.5) 2.9 (1.1-6.9) 2.6 (1.0-6.4) 1.4 (0.5-3.9) 2.3 (1.4-3.6) Venom 3.0 (1.1-7.2) 3.2 (1.4-6.8) 1.3 (0.3-3.9) 1.2 (0.4-3.2) 2.0 (1.2-3.1) Drug 2.4 (0.8-6.4) 4.1 (2.0-8.0) 3.3 (1.6-6.7) 3.5 (1.9-6.2) 3.2 (2.2-4.6) Unknown 6.0 (3.1-11.0) 4.1 (2.0-8.0) 13.8 (9.8-19.0) 9.7 (6.8-13.4) 9.8 (8.1-11.9) Reacted to peanut among those with known peanut allergy 51.3 (35.0-67.3) 31.2 (19.1-46.4) 32.2 (20.1-45.8) 39.5 (28.7-51.4) 37.6 (31.2-44.3) Reacted to tree nut among those with known tree nut allergy 52.2 (31.1-72.6) 46.7 (22.3-72.6) 54.2 (33.2-73.8) 24.4 (12.9-40.6) 32.3 (23.2-42.7) Reacted to milk among those with known milk allergy 55.6 (22.7-84.7) 35.0 (16.3-59.1) 45.0 (23.8-68.0) 34.4 (19.7-52.3) 37.1 (27.3-48.0) Reacted at home 54.1 (46.0-62.0) 56.1 (48.4-63.6) 56.7 (49.1-64.0) 48.3 (42.4-54.2) 53.0 (49.5-56.5) Anaphylaxis in the context of exercise 7.9 (4.2-14.1) 9.3 (5.3-15.7) 6.7 (3.3-12.6) 6.2 (3.7-10.0) 7.3 (5.5-9.6) Table E2 Anaphylaxis triggers and reaction history Reaction % (95% CI) Year 1 Year 2 Year 3 Year 4 All 4 years Mild 29.3 (22.7-40) 23.4 (18.1-29.7) 21.3 (16.4-27.2) 21.7 (17.5-26.5) 23.3 (0.2-26.1) Moderate 64.1 (56.2-71.2) 73.9 (67.4-79.4) 76.6 (70.6-81.7) 73.0 (67.9-77.6) 72.5 (69.6-75.3) Severe 6.6 (3.5-11.7) 2.8 (1.1-6.2) 2.1 (0.8-5.1) 5.3 (3.2-8.4) 4.1 (3.0-5.6) Table E3 Anaphylaxis reaction severity Mild anaphylaxis: "Severe anaphylaxis included cyanosis, hypoxia (saturation <92%), respiratory arrest, hypotension, dysrhythmia, confusion, or loss of consciousness.6 Reaction, % (95% CI) Univariate OR Multivariate OR Age 1.06 (1.00-1.11) 1.1 (1.03-1.2) Sex: male 1.41 (0.74-2.69) 1.41 (0.74-2.69) Asthma 1.42 (0.70-2.90) 1.42 (0.70-2.90) Eczema 1.23 (0.56-2.74) 1.23 (0.56-2.74) Use of epinephrine outside ED 0.25 (0.09-0.71) 0.25 (0.04-0.6) Use of antihistamines outside ED 0.5 (0.23-0.94) 0.5 (0.20-1.18) Use of antihistamines inside ED 3.6 (1.39-9.21) 3.6 (1.39-9.21) Severe anaphylaxis 12.4 (5.62-27.29) 17.3 (6.1-49.2) Anaphylaxis triggered by peanut 2.15 (1.11-4.19) 2.9 (1.1-8.5) Anaphylaxis triggered by tree nut 3.5 (1.22-10.03) 7.2 (2.6-20.2) Anaphylaxis triggered by milk 1.7 (0.57-4.87) 5.2 (1.4-20.0) Anaphylaxis associated with exercise 0.8 (0.18-3.45) 0.9 (0.15-5.2) Anaphylaxis at home 1.2 (0.62-2.40) 1.2 (0.62-2.40) Table E4 Univariate and multivariate logistic regression for >=2 doses of epinephrine used in anaphylaxis in the ED