title: Anaphylaxis in the Pediatric Emergency Department: Analysis of 133 Cases After an Allergy Workup.
abstract: BACKGROUND
  Data on the incidence and characteristics of pediatric anaphylaxis are scarce. Reported causes of anaphylaxis are mostly those suspected by the physician in the emergency department (ED), which may not coincide with the real triggers.
  
  
  OBJECTIVE
  To investigate the incidence, management, and etiology of pediatric anaphylaxis in the ED of a Spanish tertiary hospital and to determine the concordance between the suspected etiology in the ED and diagnosis after the allergy workup.
  
  
  METHODS
  We performed an observational, descriptive study of all patients with anaphylaxis attended in the pediatric ED from 2012 to 2014. Cases were considered anaphylaxis based on National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria. We recorded data on clinical characteristics, management, etiology suspected by the ED physician and patient (or relatives), and the workup performed in the allergy department.
  
  
  RESULTS
  We recorded 133 cases of anaphylaxis (incidence, 0.12%), with 20 cases (15%) recorded in children younger than 12 months. Anaphylaxis was correctly diagnosed in the ED in 70 cases (53%). Food allergy was the cause of anaphylaxis in 106 out of 118 studied in the allergy department (AD) (90%). The final etiology differed from the etiology initially suspected in the ED in 42 cases (39%). After the study, the frequency of patients with unidentified triggers decreased by 75%.
  
  
  CONCLUSIONS
  The incidence of anaphylaxis is higher in children than previously reported in adults from the same center, and food is the trigger in most cases. To prevent erroneous diagnoses, the etiology of anaphylaxis should be established after an appropriate workup.
authors.affiliation: Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute, Madrid, Spain. Electronic address: alberto@alvarezperea.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Alvarez-Perea
authors.affiliation: Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Ameiro
authors.affiliation: Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Morales
authors.affiliation: Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Zambrano
authors.affiliation: Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Guzmán
authors.affiliation: Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute, Madrid, Spain; Biomedical Research Network on Rare Diseases (CIBERER)-U761, Madrid, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Zubeldia
authors.affiliation: Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute, Madrid, Spain; Biomedical Research Network on Rare Diseases (CIBERER)-U761, Madrid, Spain.
authors.forename: María L
authors.initials: ML
authors.lastname: Baeza
mesh_terms: D000293:Adolescent; D000328:Adult; D000707:Anaphylaxis / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000517:prevention & control; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
chemical_list: D004837:Epinephrine
keywords: Anaphylaxis; Diagnosis; Emergency department; Epidemiology; Epinephrine; Etiology; Food allergy; Pediatric