title: The Risk of Recurrent Anaphylaxis.
abstract: To determine the recurrence rate of anaphylaxis in children medically attended in an emergency department (ED), we performed a prospective cohort study to evaluate prehospital and ED management of children with recurrent anaphylaxis and to assess factors associated with recurrent anaphylaxis.
  
  
  
  As part of the Cross-Canada Anaphylaxis Registry, parents of children with anaphylaxis identified prospectively in 3 EDs and through an emergency medical response service were contacted annually after presentation and queried on subsequent reactions. Cox regression analysis determined factors associated with recurrence.
  
  
  
  Among 292 children who were registered as having had medical attended anaphylaxis, 68.5% completed annual follow-up questionnaires. Forty-seven patients experienced 65 episodes of anaphylaxis during 369 patient-years of follow-up. Food was the trigger in 84.6% of cases, and epinephrine was used in 66.2%. In 50.8%, epinephrine was used outside the health care facility, and 81.7% were brought to a health care facility for treatment. Asthma, reaction triggered by food, and use of epinephrine during the index episode increased the odds of recurrent reaction. Patients whose initial reaction was triggered by peanut were less likely to have a recurrent reaction.
  
  
  
  We report a yearly anaphylaxis recurrence rate of 17.6% in children. There is substantial underuse of epinephrine in cases of anaphylaxis. Educational programs that promote effective avoidance strategies and prompt use of epinephrine are required.
authors.affiliation: Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: O'Keefe
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: Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Yvan
authors.initials: Y
authors.lastname: St Pierre
authors.affiliation: Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mill
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: Montreal Children's Hospital, Emergency Department, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Harley
authors.initials: H
authors.lastname: Eisman
authors.affiliation: Food Directorate, Health Canada, Ottawa, Ontario, Canada.
authors.forename: Sebastien
authors.initials: S
authors.lastname: La Vieille
authors.affiliation: Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Reza
authors.initials: R
authors.lastname: Alizadehfar
authors.affiliation: Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.affiliation: Department of Emergency Medicine, Sacré-Coeur Hospital, University of Montréal, Montreal, Quebec, Canada.
authors.forename: Judy
authors.initials: J
authors.lastname: Morris
authors.affiliation: Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Gravel
authors.affiliation: Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Moshe
authors.initials: M
authors.lastname: Ben-Shoshan
mesh_terms: D000707:Anaphylaxis / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment
chemical_list: D004837:Epinephrine
keywords: anaphylaxis; epinephrine; food allergy; risk