Anaphylaxis in a New York City pediatric emergency department: triggers, treatments, and outcomes.
BACKGROUND
Anaphylaxis incidence is increasing.


OBJECTIVE
We sought to characterize anaphylaxis in children in an urban pediatric emergency department (PED).


METHODS
We performed a review of PED records for anaphylactic reactions over 5 years.


RESULTS
We identified 213 anaphylactic reactions in 192 children (97 male patients): 6 were infants, 20 had multiple reactions, and the median age was 8 years (age range, 4 months to 18 years). Sixty-two reactions were coded as anaphylaxis; 151 additional reactions met the second symposium anaphylaxis criteria. There was no increase in incidence over 5 years. The triggers included the following: foods, 71%; unknown, 15%; drugs, 9%; and "other," 5%. Food was more likely to be a trigger in multiple PED visits (P = .03). Epinephrine was administered in 169 (79%) reactions; in 58 (27%) reactions epinephrine was administered before arrival in the PED. Patients with Medicaid were less likely to receive epinephrine before arrival in the PED (P < .001). Twenty-eight (14.6%) patients were hospitalized, 9 in the intensive care unit. For 13 (6%) of the reactions, 2 doses of epinephrine were administered; 69% of the patients treated with 2 doses of epinephrine were hospitalized compared with 12% of the patients treated with a single dose (P < .001). Administration of both epinephrine doses before arrival to the PED was associated with a lower rate of hospitalization compared with epinephrine administration in the PED (P = .05).


CONCLUSIONS
Food is the main anaphylaxis trigger in the urban PED, although the International Classification of Diseases-ninth revision code for anaphylaxis is underused. Treatment with 2 doses of epinephrine is associated with a higher risk of hospitalization; epinephrine treatment before arrival to the PED is associated with a decreased risk. Children with Medicaid are less likely to receive epinephrine before arrival in the PED.
Department of Pediatrics and Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY, USA.
Faith
F
Huang
Kanwaljit
K
Chawla
Kirsi M
KM
Järvinen
Anna
A
Nowak-Węgrzyn
D000293:Adolescent; D000707:Anaphylaxis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology / Q000209:etiology; D006633:Histamine Antagonists / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009519:New York City; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use
D006633:Histamine Antagonists; D013256:Steroids; D004837:Epinephrine