Increasing visits for anaphylaxis and the benefits of early epinephrine administration: A 4-year study at a pediatric emergency department in Montreal, Canada

Anaphylaxis across two Canadian pediatric centers: evaluating management disparities

“…Furthermore, a recent study by our group reveals almost a doubling in anaphylaxis over a 4-year period in Montreal 9. The high burden of anaphylaxis in the ED, in particular from food-induced reactions, is in keeping with reports on increased prevalence of food allergy, especially peanut allergy 17.…”

“…Similarly, a recent Cochrane study showed inconclusive evidence for steroid use in anaphylaxis 25. Given that studies by our group and others7,9 suggest that early epinephrine use is key in the management of anaphylaxis and given that epinephrine use at the pre-hospital setting was similar between the two centers, it is not surprising that in-hospital differences in the use of epinephrine did not increase the risk of negative outcomes including admission to the intensive care unit or hospital ward. Univariate and multivariate logistic regression analyses did not reveal any significant associations between admission and patient’s demographics, comorbidities, type of anaphylaxis trigger, or timing of epinephrine/antihistamines/steroid administration (pre-arrival or at the ED).…”

“…Care-provider factors likely include training and access to educational programs. Prior work by our group specifically at the MCH ED revealed that pre-hospital use of antihistamines and/or steroids often replaces early use of epinephrine8,9 and that prompt use of epinephrine prior to hospital arrival is crucial in the management of anaphylaxis and reduces the risk for uncontrolled reactions requiring multiple doses of epinephrine 9. It is possible that the findings of these earlier studies that have been presented to physicians at the MCH ED led to lower use of these medications at the MCH ED compared to the BCCH ED.…”

“…Parents or legal guardians of patients recruited at the ED provided written informed consent at each site between June 2014 and June 2016. During this time period, cases that were missed prospectively were identified via chart review with the International Classification of Disease codes (ICD-10) or written discharge diagnoses relating to anaphylaxis or allergic reaction and retrospectively captured as previously described 9,14. Two independent teams (three reviewers at the BCCH and two reviewers at the MCH) analyzed all cases to verify that they met the definition of anaphylaxis.…”

“…In the United States, the rate of anaphylaxis presentations to pediatric emergency departments (PEDs) ranges from 0.18% to 0.45%,2–4 and globally, the incidence of anaphylaxis is increasing 3,5–7. In Canada, the overall prevalence of anaphylaxis is unknown, but we have previously reported that 0.21% of PED visits are due to anaphylaxis and that this percentage almost doubled over a 4-year period at the emergency department (ED) in Montreal 8,9. However, it is not clear if this high rate of anaphylaxis is reflective of PEDs in other Canadian provinces.…”