Emergency and Hospital Care for Food-Related Anaphylaxis in Children.
OBJECTIVE
Among patients with food-related anaphylaxis, to describe trends in emergency and hospital care and determine the revisit rate.


METHODS
This retrospective cohort study included children 6 months to 18 years of age with food-related anaphylaxis from 37 children's hospitals between 2007 and 2012. Summary statistics and trends for patient characteristics were evaluated. Multivariable regression was used to identify predictors for hospital admission. Revisit rates to either the emergency department (ED) and/or inpatient unit were calculated.


RESULTS
7303 patients were evaluated in the ED; 3652 (50%) were admitted to the hospital. Hospital admission rates varied widely (range, 20%-98%). Food-related anaphylaxis increased from 41 per 100 000 ED visits to 72 per 100 000 while hospital admission rates did not change. Males (odds ratio [OR], 1.2 [95% confidence interval (CI), 1.0-1.4]), patients < 1 year old (OR, 1.8 [95% CI, 1.3-2.5]), those with anaphylaxis to either peanut (OR, 1.2 [95% CI, 1.0-1.5]) or tree nut (OR, 1.7 [95% CI, 1.3-2.1]), and patients with asthma (OR, 7.4 [95% CI, 5.8-9.3]) or a chronic complex condition (OR, 5.2 [95% CI, 3.0-9.0]) were more likely to be admitted to the hospital. The 3-day revisit rate was 3% for patients discharged from the ED and 0.6% for those admitted on the index visit.


CONCLUSIONS
The incidence of food-related anaphylaxis in pediatric EDs is increasing, but rates of hospital admission are stable. Hospital admission is common but widely variable. Further research is needed to identify optimal management practices for this potentially life-threatening problem.
Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, 98105-0371, USA.; and joshua.parlaman@seattlechildrens.org.
Joshua P
JP
Parlaman
Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington; and Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington.
Assaf P
AP
Oron
Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington; and Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington.
Neil G
NG
Uspal
Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington; and.
Katherine N
KN
DeJong
Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington; and Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington.
Joel S
JS
Tieder
D000293:Adolescent; D000707:Anaphylaxis / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology