title: Rate, triggers, severity and management of anaphylaxis in adults treated in a Canadian emergency department.
abstract: BACKGROUND
  The Cross-Canada Anaphylaxis Registry (C-CARE) assesses the triggers and management of anaphylaxis and identifies predictors of the development of severe allergic reactions and of epinephrine use. Here, we present data from an urban adult tertiary care emergency department (ED) in Montreal, Canada.
  
  
  METHODS
  Potential anaphylaxis cases were identified using ICD-10 codes related to anaphylaxis or allergic reactions. Putative cases underwent chart review to ensure they met anaphylaxis diagnostic criteria. Demographic, clinical and management data were collected. Multivariate logistic regressions were conducted to assess the effect of demographic characteristics, triggers, and comorbidities on severity and management of reactions.
  
  
  RESULTS
  Among 37,730 ED visits, 0.26% (95% CI 0.21, 0.32) fulfilled the definition of anaphylaxis. Food was the suspected trigger in almost 60% of cases. Epinephrine was not administered in almost half of moderate-to-severe cases, and similar numbers of individuals with moderate-to-severe reactions were not prescribed an epinephrine autoinjector. Reaction to shellfish was associated with more severe reactions (OR 13.9; 95% CI 2.2, 89.4). Older individuals and those not receiving steroids were more likely managed without epinephrine (OR 1.04; 95% CI 1.01, 1.07 and OR 2.97; 95% CI 1.05, 8.39, respectively).
  
  
  CONCLUSIONS
  Anaphylaxis accounted for a substantial number of ED visits in adults, and the most common trigger was food. There is non-adherence to guidelines recommending epinephrine use for all cases of anaphylaxis. We postulate that this may be related to concerns regarding the side effects of epinephrine in adults.
authors.affiliation: Division of Dermatology, Department of Medicine, Montreal Children's Hospital, Montreal, Que., Canada.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Asai
authors.forename: Yarden
authors.initials: Y
authors.lastname: Yanishevsky
authors.forename: Ann
authors.initials: A
authors.lastname: Clarke
authors.forename: Sebastian
authors.initials: S
authors.lastname: La Vieille
authors.forename: J Scott
authors.initials: JS
authors.lastname: Delaney
authors.forename: Reza
authors.initials: R
authors.lastname: Alizadehfar
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.forename: Christopher
authors.initials: C
authors.lastname: Mill
authors.forename: Judy
authors.initials: J
authors.lastname: Morris
authors.forename: Moshe
authors.initials: M
authors.lastname: Ben-Shoshan
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy* / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005512:Food Hypersensitivity / Q000188:drug therapy* / Q000453:epidemiology; D019983:Guideline Adherence; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D012758:Shellfish / Q000009:adverse effects
chemical_list: D006633:Histamine Antagonists; D004837:Epinephrine