Analysis of food-allergic and anaphylactic events in the National Electronic Injury Surveillance System

Ross, M; Ferguson, Martine; Street, Debra; Klontz, Karl C.; Schroeder, Tom; Luccioli, Stefano

doi:10.1016/j.jaci.2007.10.012

Cited by 202 publications

(150 citation statements)

References 23 publications

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“…For example, a 2-month retrospective review of ED-food allergic events reported at 34 sites within the database of the US National Electronic Injury Surveillance System found that 62% of anaphylaxis cases did not receive the correct diagnosis. [32] Our data would suggest that some of these EDs probably did not use a formal definition of anaphylaxis. Would this help providers be more compliant with published guidelines?…”

Section: Discussionmentioning

confidence: 94%

“…[1,8,19,27–32] Regardless of the age of the patients or the causative trigger of the acute allergic reaction, the number of episodes receiving a diagnosis of anaphylaxis increased with application of the additional criteria, sometimes, dramatically. For example, a 2-month retrospective review of ED-food allergic events reported at 34 sites within the database of the US National Electronic Injury Surveillance System found that 62% of anaphylaxis cases did not receive the correct diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…However, while the data cannot be directly compared, the trends from our “real world” survey are reassuringly similar to trends reported for retrospective case studies that looked individually at the diagnosis, treatment, or discharge of patients with anaphylaxis in US EDs. [9,10,19,27,32] We believe that the limitations of our survey are not likely to be clinically significant and that the reported findings can be generalized to most American EDs.…”

Section: Limitationsmentioning

confidence: 91%

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Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

Russell

Farrar

Nowak

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers. The study aimed to evaluate how emergency departments (EDs) in the United States (US) manage anaphylaxis in relation to guideline recommendations.METHODS:This was an online anonymous survey of a random sample of EM health providers in US EDs.RESULTS:Data analysis included 207 EM providers. For respondent EDs, approximately 9% reported using agreed-upon clinical criteria to diagnose anaphylaxis; 42% reported administering epinephrine in the ED for most anaphylaxis episodes; and <50% provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge. Most provided some written materials, and follow-up with a primary care clinician was recommended.CONCLUSIONS:This is the first cross-sectional survey to provide “real-world” data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine. Prospective research is recommended.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 91%

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Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

Russell

Farrar

Nowak

et al. 2013

World Journal of Emergency Medicine

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“…According to two important studies [7,8], only 1 % of the acute systemic allergic reactions evaluated in emergency departments had been diagnosed as anaphylaxis, as most of the systemic allergic reactions received a diagnosis of acute allergic or acute hypersensitivity reaction. In another study from hospital emergency departments in the United States, 57 % of very likely episodes of food anaphylaxis did not receive a diagnosis of anaphylaxis [9]. …”

mentioning

confidence: 97%

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

et al. 2013

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There are wide differences in estimated incidence and prevalence of anaphylaxis because of the absence, until recently, of a universal consensus on the definition of anaphylaxis and the different source of collected data. We aimed to estimate the incidence of food anaphylaxis based on the database of Piemonte Region (Italy) Reference Center for Severe Allergic Reactions. All cases of severe food allergic reactions reported in 2010 were studied. Clinical data associated to the reports were evaluated according to National Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network diagnostic criteria of anaphylaxis. 75 % of the 778 cases were classified as food anaphylaxis (incidence of 13/100,000 personyears, ranging from 9.9 in adults to 29/100,000 person-years in children). Nuts were the most frequent foods causing anaphylaxis. Milk and eggs were responsible for anaphylaxis more often in children, while peach, vegetables and crustaceans were in adults. Cardiovascular symptoms were more frequent in adults. Gastrointestinal involvement was more frequent in children. A high prevalence of respiratory allergic comorbidities was observed. Food is an important cause of anaphylaxis, particularly in subjects with respiratory allergic comorbidities. Children and adults differ in triggers and clinical presentation of anaphylaxis.Keywords: Anaphylaxis, Food allergy, Epidemiology, Allergy Introduction Population-based studies estimate the incidence of anaphylaxis in western countries to be in the range of 4-50 per 100,000 person-years [1, 2], with a true lifetime prevalence in the range of 0.05-2 % [3]. Foods are reported to be the most important trigger of anaphylaxis, being responsible for 33.2-56 % of all anaphylaxis cases [4]. The other two principal triggers of anaphylaxis are insect stings and drugs [1,5]. The relative contribution of each of these triggers to anaphylaxis may differ according to the study design, study population, or geographic area. The wide differences in the estimated incidences and prevalences of anaphylaxis are the direct result of the absence, until recently, of a universal consensus on the definition of anaphylaxis and the different source of collected data. For this reason in 2005 the National Institute of Allergy and Infectious Disease (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) developed a very useful preliminary definition, based on diagnostic criteria [6]. The symposium defined anaphylaxis as: "a serious allergic reaction that is rapid in onset and may cause death". Clinically, involvement of at least two organs (skin or mucosal tissue, cardiovascular apparatus, breathing apparatus, gastrointestinal tract) is required, or a sudden reduced blood pressure along with a temporal relationship (generally minutes) to a potential causative agent. A problematic issue with this definition, which may explain the under-reporting or misreporting of anaphylaxis cases, is the failure to agree among health care providers on the severity threshold for classi...

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“…Indeed, studies have shown that a large percentage of patients (57%) who present to the ER with anaphylaxis are misdiagnosed 2, 3, 20, 21. The first line of evidence for diagnosing anaphylaxis includes clinical signs.…”

Section: Diagnosismentioning

confidence: 99%

Drug‐induced anaphylaxis in the emergency room

Takazawa

Oshima

Saito

2017

Acute Medicine & Surgery

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Anaphylaxis is a life‐threatening, systemic allergic reaction that presents unique challenges for emergency care practitioners. Anaphylaxis occurs more frequently than previously believed. Therefore, proper knowledge regarding the epidemiology, mechanisms, symptoms, diagnosis, and treatment of anaphylaxis is essential. In particular, the initial treatment strategy, followed by correct diagnosis, in the emergency room is critical for preventing fatal anaphylaxis, although making a diagnosis is not easy because of the broad and often atypical presentation of anaphylaxis. To this end, the clinical criteria proposed by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network are useful, which, together with a differential diagnosis, could enable a more accurate diagnosis. Additional in vitro tests, such as plasma histamine and tryptase measurements, are also helpful. It should be emphasized that adrenaline is the only drug recommended as first‐line therapy in all published national anaphylaxis guidelines. Most international anaphylaxis guidelines recommend injecting adrenaline by the intramuscular route in the mid‐anterolateral thigh, whereas i.v. adrenaline is an option for patients with severe hypotension or cardiac arrest unresponsive to intramuscular adrenaline and fluid resuscitation. In addition to the route of administration, choosing the appropriate dose of adrenaline is essential, because serious adverse effects can potentially occur after an overdose of adrenaline. Furthermore, to avoid future recurrence of anaphylaxis, providing adrenaline auto‐injectors and making an etiological diagnosis, including confirmation of the offending trigger, are recommended for patients at risk of anaphylaxis before their discharge from the emergency room.

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Analysis of food-allergic and anaphylactic events in the National Electronic Injury Surveillance System

Cited by 202 publications

References 23 publications

Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

Drug‐induced anaphylaxis in the emergency room

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