title: Food-induced anaphylaxis among commercially insured US adults: patient concordance with postdischarge care guidelines.
abstract: BACKGROUND
  Food-induced anaphylaxis is a potentially life-threatening condition that frequently results in emergency department (ED) visits and/or hospitalization. Little information is available on patient compliance with recommended postdischarge anaphylaxis care.
  
  
  OBJECTIVE
  To describe patient characteristics, concordance with recommended postdischarge care, and risk of repeated events among adults with an initial ED visit and/or hospitalization for food-induced anaphylaxis.
  
  
  METHODS
  In this retrospective study of health care claims, adults with an ED visit and/or hospitalization for food-induced anaphylaxis were identified from the 2002-2008 Truven Health MarketScan Databases by using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. The first identified ED visit and/or hospitalization was the index event. Data from patients with continuous medical and prescription coverage for ≥1 year before and after the index event were retained for analysis. Analyses included baseline demographic and clinical characteristics, postdischarge epinephrine autoinjector (EAI) prescription fills and allergist/immunologist visits, and repeated events in the 1-year postindex period.
  
  
  RESULTS
  Patients (n = 1370) had a mean (SD) age of 44 ± 15 years, 58% were women. Most (86%) were seen in the ED and/ discharged from the ED. Within 1 year after discharge, 54% of adults had filled ≥1 EAI prescription (71% within 1 week) and 22% had ≥1 allergist/immunologist visit (53% within 4 weeks). Overall, 73 patients (5%) had evidence of a subsequent anaphylaxis-related ED visit and/or hospitalization 1 year after discharge.
  
  
  CONCLUSIONS
  Concordance with recommended postdischarge anaphylaxis care was low among adults with food-induced anaphylaxis. Within 1 year after discharge, 54% of patients filled an EAI prescription and 22% consulted an allergist/immunologist.
authors.affiliation: Xcenda, Palm Harbor, Fla.
authors.forename: Pamela B
authors.initials: PB
authors.lastname: Landsman-Blumberg
authors.affiliation: Sanofi US, Bridgewater, NJ.
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wei
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY (previously fellow at Rutgers, The State University of New Jersey, Newark, NJ, and on assignment at Sanofi US until 2011).
authors.forename: Damon
authors.initials: D
authors.lastname: Douglas
authors.affiliation: Xcenda, Palm Harbor, Fla.
authors.forename: David M
authors.initials: DM
authors.lastname: Smith
authors.affiliation: Department of Emergency Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.affiliation: Department of Emergency Medicine, and Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. Electronic address: ccamargo@partners.org.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000453:epidemiology / Q000628:therapy*; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007348:Insurance, Health; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D018926:Anti-Allergic Agents; D004837:Epinephrine
keywords: Allergist; Concordance; Emergency department; Epinephrine autoinjector; Food-induced anaphylaxis; Hospitalization; Immunologist; Postdischarge care; Prescription; Treatment guidelines