title: Anaphylaxis cases presenting to primary care paramedics in Quebec.
abstract: Data on anaphylaxis cases in pre-hospital settings is limited. As part of the Cross Canada Anaphylaxis Registry (C-CARE), we assessed anaphylaxis cases managed by paramedics in Outaouais, Quebec. A software program was developed to prospectively record demographic and clinical characteristics as well as management of cases meeting the definition of the anaphylaxis. Univariate and multivariate logistic regressions were compared to assess factors associated with severity of reactions and epinephrine use. Among 33,788 ambulance calls of which 23,486 required transport, 104 anaphylaxis cases were identified (anaphylaxis rate of 0.31% [95%CI, 0.25%, 0.37%] among all ambulance calls and 0.44% [95%CI, 0.36%, 0.54%] among those requiring transport). The median age was 46.8 years and 41.3% were males. The common triggers included food (32.7% [95%CI, 24.0%, 42.7%]), drugs (24.0% [16.4%, 33.6%]), and venom (17.3% [10.8%, 26.2%]). Among all reactions, 37.5% (95%CI, 28.4%, 47.6%) were severe. Epinephrine was not administered in 35.6% (95%CI, 26.6%, 45.6%) of all cases. Males were more likely to have severe reactions (Odds ratio [OR]: 2.50 [95%CI, 1.03, 6.01]). Venom-induced reactions and severe anaphylaxis were more likely to be managed with epinephrine (OR: 6.9 [95%CI, 1.3, 35.3] and 4.2 [95%CI, 1.5, 12.0], respectively). This is the first prospective study evaluating anaphylaxis managed by paramedics. Anaphylaxis accounts for a substantial proportion of the cases managed by paramedics in Outaouais, Quebec and exceeds prior reports of the proportion of Quebec emergency room visits attributed to anaphylaxis. Although guidelines recommend prompt use of epinephrine for all cases of anaphylaxis, more than a third of cases did not receive epinephrine. It is crucial to develop educational programs targeting paramedics to promote the use of epinephrine in all cases of anaphylaxis regardless of the specific trigger.
authors.affiliation: Technion American Medical Students Program Haifa Israel.
authors.forename: Nofar
authors.initials: N
authors.lastname: Kimchi
authors.affiliation: Division of Rheumatology, Department of Medicine University of Calgary Calgary, Alberta Canada.
authors.forename: Ann
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Directeur Médical Régional des Services Préhospitaliers D'urgence de L'Outaouais Quebec Canada.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Moisan
authors.affiliation: Directrice médicale nationale Direction Adjointe de Services Préhospitaliers D'urgence MSSS, Quebec Canada.
authors.forename: Colette
authors.initials: C
authors.lastname: Lachaine
authors.affiliation: Food Directorate Health Canada Ottawa, Ontario Canada.
authors.forename: Sebastien
authors.initials: S
authors.lastname: La Vieille
authors.affiliation: Division of Dermatology, Department of Medicine Queen's University Kingston, Ontario Canada.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Asai
authors.affiliation: Department of Epidemiology and Biostatistics McGill University Montreal, Quebec Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.affiliation: School of Population and Public Health University of British Columbia Vancouver, British Columbia Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Mill
authors.affiliation: Division of Allergy and Clinical Immunology, Department of Medicine McGill University Health Centre Montreal, Quebec Canada.
authors.forename: Moshe
authors.initials: M
authors.lastname: Ben-Shoshan
keywords: Anaphylaxis; Emergency Medical Services; epinephrine; management; triggers