Emergency and Hospital Care for Food-Related Anaphylaxis in Children

Abstract

A B S T R A C TOBJECTIVES: Among patients with food-related anaphylaxis, to describe trends in emergency and hospital care and determine the revisit rate.METHODS: This retrospective cohort study included children 6 months to 18 years of age with food-related anaphylaxis from 37 children's hospitals between 2007 and 2012. Summary statistics and trends for patient characteristics were evaluated. Multivariable regression was used to identify predictors for hospital admission. Revisit rates to either the emergency department (ED) and/or inpatient unit were calculated.RESULTS: 7303 patients were evaluated in the ED; 3652 (50%) were admitted to the hospital.Hospital admission rates varied widely (range, 20%-98% .0-9.0]) were more likely to be admitted to the hospital. The 3-day revisit rate was 3% for patients discharged from the ED and 0.6% for those admitted on the index visit. CONCLUSIONS:The incidence of food-related anaphylaxis in pediatric EDs is increasing, but rates of hospital admission are stable. Hospital admission is common but widely variable. Further research is needed to identify optimal management practices for this potentially life-threatening problem.

Anaphylaxis triggers in a large tertiary care hospital in Qatar: a retrospective study

“…The major causative triggers of food-induced anaphylaxis in Qatar were nuts and eggs, a finding that was consistent with a Saudi finding reported in 2015 [14]. Peanuts, a major trigger of food-related anaphylaxis in the United States [7, 9, 22], is ranked in the fourth position after seafood in Qatar. In a prospective cohort study conducted in Qatar from 2007 to 2010, anaphylaxis induced by cow’s milk proteins (CMP) was found in 10 children out of 38 allergic subjects and suggested camel milk as a safer alternative choice after being experimentally tested [30, 31].…”

“…In addition to potential differences in the genetic make-up, different life style and dietary patterns as well as differential prevalence of illnesses and use of varying medications may be some of the factors that may or may not contribute to such differences [18, 23]. In general, anaphylaxis was common [7–9, 20, 21], more associated with repeated use of epinephrine [27] and more fatal [23] among Caucasians compared to Black, Latino/Hispanic and Asian ethnicities. In contrast, Mahdavinia et al (2017) reported that Caucasians had a lower rate of food allergy associated anaphylaxis than African American and Hispanic children [37].…”

“…With a larger study population, anaphylaxis induced by cow’s milk was accounted for 61 (10.6%) from 2012 to 2016. In comparison, the prevalence of CMP anaphylaxis resulted in 6–9% of children hospital and emergency admission in the USA [7, 19, 21] and 10% in the UK [44]. CMP anaphylaxis accounted for 8 fatalities in UK children during the period from 1992 to 2012 [13].…”

“…Several studies from USA, UK, and Australia suggested that the incidence of anaphylaxis is on a gradual rise over the last two decades [7–14]. To estimate the incidence, prevalence, and triggers, scientists have used different methodologies including patients’ case reports [15–17], international medical coding systems [7–9, 18–24], hospital admission rates [11, 13, 25, 26], public surveys and epinephrine dispense records [10, 12, 21, 25, 27, 28]. These studies have demonstrated that distribution of anaphylaxis tends to fluctuate based on age, gender, race, geographical residence, and socioeconomic status of involved subjects.…”

Barriers to the Administration of Epinephrine in Schools

“…Indeed, as many as one fourth of those who experience an anaphylactic reaction in the school setting have no history of allergy . Among school children, food as a trigger for anaphylaxis has become a significant concern as the prevalence of food allergies continues to increase, as does the frequency of pediatric emergency department visits due to food‐induced anaphylaxis . It is now estimated that food allergies affect 1 in 20 school‐aged children, which translates to an average of at least 1 student per classroom…”