Anaphylaxis in a New York City pediatric emergency department: Triggers, treatments, and outcomes

Faith Huang, Kanwaljit Chawla, Kirsi M. Järvinen, Anna Nowak-Wȩgrzyn

Research output: Contribution to journalArticlepeer-review

181 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)162-168.e3
JournalJournal of Allergy and Clinical Immunology
Volume129
Issue number1
DOIs
StatePublished - Jan 2012

Keywords

  • Children
  • anaphylaxis
  • autoinjectable epinephrine
  • food allergy
  • food-induced anaphylaxis
  • peanut allergy
  • pediatric emergency department
  • seafood allergy

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