Epidemiology of anaphylaxis among children and adolescents enrolled in a health maintenance organization

Bohlke, Kari; Davis, Robert L.; DeStefano, Frank; Marcy, S. Michael; Braun, M. Miles; Thompson, Robert S.

doi:10.1016/j.jaci.2003.11.033

Cited by 270 publications

(230 citation statements)

References 19 publications

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“…Table 4 shows the sensitization pattern to common inhalant allergens observed in 481 patients (183 children and 298 adults), with no significant difference between children and adults. Discussion According to our data, the incidence of food anaphylaxis in the general population of Piemonte Region appears to be similar to the incidence reported in the literature, which range from 10.5 per 100,000 person year to 32 per 100,000 person year [14][15][16]. We cannot exclude underestimation of the true incidence of food anaphylaxis, in particular, milder forms.…”

Section: Resultssupporting

confidence: 82%

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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Section: Resultssupporting

confidence: 82%

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

et al. 2013

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“…[19] The published data confirm the greater use of second-line agents than epinephrine in the treatment of anaphylaxis in the ED with approximately 80% of patients receiving antihistamines (range 51%–92%)[1,8–10,20,31–34] and 60%, corticosteroids (range 34%–89%). [1,8–10,31,33] While we did not specifically ask about these second-line agents, several respondents commented that antihistamines were a preferred first treatment for anaphylaxis in their ED.…”

Section: Discussionmentioning

confidence: 86%

“…However, we were able to find 13 US studies (8 in adults, 5 in adolescents and children) in which individual gaps in diagnosis, treatment, and follow-up could be inferred. [1,8–10,19,20,27–34] The applicable data are summarized in Table 2.…”

Section: Discussionmentioning

confidence: 99%

“…[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%

“…For the US, a review of anaphylaxis in children and adolescents over a 6-year period reported that 71% of cases were treated at an emergency department (ED) or urgent care center. [1] The number of annual ED visits for anaphylaxis in the US is estimated to be as high as 500 000. [2]…”

Section: Introductionmentioning

confidence: 99%

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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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H1-antihistamines for the treatment of anaphylaxis with and without shock

Azimullah¹,

Brown²,

Simons³

et al. 2006

Cochrane Database of Systematic Reviews

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Epidemiology of anaphylaxis among children and adolescents enrolled in a health maintenance organization

Cited by 270 publications

References 19 publications

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

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

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

H1-antihistamines for the treatment of anaphylaxis with and without shock

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