Are Children with a History of Asthma More Likely to Have Severe Anaphylactic Reactions? A Retrospective Cohort Study

Abstract

Objective To assess whether a history of asthma was associated with anaphylaxis severity in children hospitalized for anaphylaxis. Study design Retrospective cohort study of children £21 years old hospitalized for anaphylaxis from 2009 to 2016. The primary outcome was severe anaphylactic reactions defined by examination findings (stridor, respiratory distress, or hypotension) or administered therapies (³2 dose of intramuscular epinephrine, continuous albuterol, vasopressors, or positive pressure ventilation). Multivariable analyses were used to assess whether a history of asthma was associated with severe anaphylactic reactions, adjusting for patient age, allergen, and history of atopic dermatitis or anaphylaxis. Results Among 603 children hospitalized for anaphylaxis, 231 (38.3%) had a history of asthma. Children with a history of asthma were older (median age, 6.6 years [IQR, 3.6-12.1] vs 4.0 years [IQR, 1.6-9.3]), more likely to have a history of anaphylaxis (38.1% vs 18.0%), and have food as the inciting allergen (68.0% vs 52.2%). Children with a history of asthma were not more likely to have severe anaphylactic reactions (OR, 0.97; 95% CI, 0.67-1.39). Conclusions Children hospitalized for anaphylaxis with a history of asthma were not more likely to have severe anaphylactic reactions compared with children without asthma. This study supports managing children with anaphylaxis based on the severity of symptomatology, and, if validated, clinicians should not consider asthma comorbidity as a stand-alone criterion for hospitalization.

Etiology, Clinical Profile, Evaluation, and Management of Stridor in Children

“…Wheeze is the characteristic finding in anaphylaxis, but stridor can be found when upper airway is affected and though stridor is less common, it is much more dangerous. A recent study found stridor in only 6.3% of cases of anaphylaxis [23].…”

Poor asthma control remains a risk factor for severe anaphylaxis

“…In support of their conclusions, the authors cite a study evaluating anaphylactic reactions from peanuts and tree nuts in an outpatient allergy center. 1 In contrast to our report, this study includes limited allergens and may represent a more severe cohort of patients with a greater predilection for asthma and/or severe anaphylaxis based on their referral to an allergy center. Thus, it is difficult to compare their findings with our own, or generalize them to the care of children presenting to emergency departments (EDs) with anaphylaxis.…”

“…We have read with interest the report by Dribin et al investigating the association between history of asthma and anaphylaxis severity in children. 1 The authors concluded that children hospitalized for anaphylaxis with a medical history of asthma were not more likely to have severe anaphylactic reactions compared with children without asthma. However, we noticed that asthma control status at the time of anaphylaxis was not determined in the study.…”

“…Menekos et al reported that higher uric acid levels were found in adults who lost more weight after bariatric surgery, but these patients were only evaluated in the first month after the surgical event. 1 In our study, adolescents with overweight or obesity were evaluated for one year, under supervised lifestyle interventions.…”

Factors influencing emergency department observation time following anaphylaxis: a systematic review

“…Nine studies exclusively focused on pediatric populations, three on adult populations, while the others included all ages. Three pairs of studies [18][19][20][21][22][23] used the same patient sample and four studies [9,[24][25][26] contained some patient overlap, but the extent was difficult to determine.…”