title: Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization.
abstract: BACKGROUND
  Food-induced anaphylaxis (FIA) is potentially life threatening. Prompt administration of epinephrine is universally recommended by current treatment guidelines.
  
  
  OBJECTIVE
  To identify factors associated with early epinephrine treatment for FIA and to specifically examine the association between early epinephrine treatment and hospitalization.
  
  
  METHODS
  A chart review study conducted at Hasbro Children's Hospital/Rhode Island Hospital. By using the International Classification of Diseases, Ninth Revision codes, we identified all patients who presented to the emergency department with FIA between January 1, 2004, and December 31, 2009. Early epinephrine treatment was defined as receipt of epinephrine before arrival to the emergency department. The independent association between early epinephrine treatment and hospitalization was assessed using logistic regression.
  
  
  RESULTS
  Among the 384 emergency department visits for FIA identified during the study period, 234 patients received epinephrine (61%). Among this subset, most (164 [70%]) received early epinephrine treatment, whereas a smaller number of patients (70 [30%]) first received epinephrine in the emergency department (late treatment). Patients who received early epinephrine treatment were older (7.4 vs 4.3 years; P = .008), were more likely to have a known food allergy (66% vs 34%; P < .001), and were more likely to own an epinephrine autoinjector (80% vs 23%; P < .001). Patients treated early were less likely to be hospitalized (17% vs 43%; P < .001). After adjusting for age, sex, and race, the patients who received early epinephrine treatment remained at significantly decreased risk of hospitalization compared with those who received late epinephrine treatment (odds ratio 0.25 [95% CI, 0.12-0.49]).
  
  
  CONCLUSIONS
  In this population, early treatment of FIA with epinephrine was associated with significantly lower risk of hospitalization. Accordingly, this study supports the benefit of prompt administration of epinephrine for the treatment of FIA.
authors.affiliation: Division of Asthma and Allergy, Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Jude T
authors.initials: JT
authors.lastname: Fleming
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, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Allergy/Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Division of Asthma and Allergy, Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI. Electronic address: srudders@lifespan.org.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Rudders
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000188:drug therapy* / Q000209:etiology*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D004837:Epinephrine
keywords: Anaphylaxis; Early treatment; Emergency department; Epinephrine; Food allergy; Hospitalization; Pediatrics