title: Accidental exposures to peanut in a large cohort of Canadian children with peanut allergy.
abstract: BACKGROUND
  We previously estimated that the annual rate of accidental exposure to peanut in 1411 children with peanut allergy, followed for 2227 patient-years, was 11.9% (95% CI, 10.6, 13.5). This cohort has increased to 1941 children, contributing 4589 patient-years, and we determined the annual incidence of accidental exposure, described the severity, management, location, and identified associated factors.
  
  
  RESULTS
  Children with physician-confirmed peanut allergy were recruited from Canadian allergy clinics and allergy advocacy organizations from 2004 to May 2014. Parents completed questionnaires regarding accidental exposure to peanut over the preceding year. Five hundred and sixty-seven accidental exposures occurred in 429 children over 4589 patient-years, yielding an annual incidence rate of 12.4% (95% CI, 11.4, 13.4). Of 377 accidental exposures that were moderate or severe, only 109 (28.9%) sought medical attention and of these 109, only 40 (36.7%) received epinephrine. Of the 181 moderate/severe accidental exposures treated outside a health care facility, only 11.6% received epinephrine. Thirty-seven percent of accidental exposures occurred at home. In multivariate analyses, longer disease duration, recruitment through an allergy advocacy association, and having other food allergies decreased the likelihood of accidental exposures. Age ≥ 13 years at study entry and living with a single parent increased the risk.
  
  
  CONCLUSIONS
  Despite increased awareness, accidental exposures continue to occur, mainly at home, and most are managed inappropriately by both health care professionals and caregivers. Consequently, more education is required on the importance of strict allergen avoidance and the need for prompt and correct management of anaphylaxis.
authors: Division of Allergy and Clinical Immunology, Department of Medicine, University of Montreal, Montreal, QC Canada.
authors: Sabrine
authors: S
authors: Cherkaoui
authors: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, QC Canada.
authors: Moshe
authors: M
authors: Ben-Shoshan
authors: Division of Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, QC Canada.
authors: Reza
authors: R
authors: Alizadehfar
authors: Division of Dermatology, Department of Medicine, Queen's University, Kingston, ON Canada.
authors: Yuka
authors: Y
authors: Asai
authors: Division of Allergy and Immunology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC Canada.
authors: Edmond
authors: E
authors: Chan
authors: Allergist/Clinical Immunologist, Calgary, AB Canada.
authors: Stephen
authors: S
authors: Cheuk
authors: Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC Canada.
authors: Greg
authors: G
authors: Shand
authors: Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC Canada.
authors: Yvan
authors: Y
authors: St-Pierre
authors: Anaphylaxis Canada, Toronto, ON Canada.
authors: Laurie
authors: L
authors: Harada
authors: Allergy/Asthma Information Association, Toronto, ON Canada.
authors: Mary
authors: M
authors: Allen
authors: Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, AB Canada.
authors: Ann
authors: A
authors: Clarke
keywords: Accidental exposure; Epidemiology; Food allergy; Peanut allergy; Treatment