title: An analysis of anaphylaxis cases at a single pediatric emergency department during a 1-year period.
abstract: Case series of anaphylaxis can vary regarding causes, treatments, and follow-up of patients. Unfortunately, case series that are specific to the pediatric population are few.
  
  
  
  To describe confirmed cases of pediatric anaphylaxis in patients presenting to a pediatric hospital emergency department (ED).
  
  
  
  We identified all ED visits with the International Classification of Diseases, Ninth Revision (ICD-9) codes 995.XX (allergic reactions) and 989.5 (sting or venom reaction) for 1 calendar year (January 1, 2014, through December 31, 2014). Cases were reviewed by an allergist and an emergency medicine physician to identify true anaphylaxis cases using National Institute of Health/National Institute of Allergy and Infectious Diseases criteria. Any questionable or debatable cases were evaluated and adjudicated by a second allergist.
  
  
  
  We identified 927 unique ED visits. Of these visits, 40 were determined to definitively meet anaphylaxis criteria. Median age of the patients was 6.5 years. A total of 70% of patients were male, and 80% were African American. Causes included foods (65%), venom or insect sting (12.5%), and medications (5%), and 17.5% were idiopathic. All patients had multiorgan involvement, with 98% having skin involvement, 78% having lower respiratory tract symptoms, and 40% having gastrointestinal symptoms. There were no deaths. Only 33% of patients received epinephrine at some point in their care. Only 12 patients were referred to an allergist, and only 4 of these were actually seen by an allergist.
  
  
  
  At our center, foods are the most common trigger for pediatric anaphylaxis. Patients continue to be undertreated, and referral to an allergist from the ED is rare.
authors.affiliation: Departments of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Wright
authors.affiliation: Department of Emergency Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Mindy
authors.initials: M
authors.lastname: Longjohn
authors.affiliation: Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Phillip L
authors.initials: PL
authors.lastname: Lieberman
authors.affiliation: Departments of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: Jlieber1@uthsc.edu.
authors.forename: Jay Adam
authors.initials: JA
authors.lastname: Lieberman
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000276:immunology; D000707:Anaphylaxis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data*; D010641:Phenotype; D012189:Retrospective Studies
chemical_list: D000485:Allergens