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The Risk of Recurrent Anaphylaxis
Andrew O'Keefe1, Ann Clarke2, Yvan St Pierre3
1Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
Insights
The yearly recurrence rate of anaphylaxis in children is 17.6%. Factors like asthma and food triggers increase recurrence risk, highlighting the need for better education on avoidance and epinephrine use.
Area of Science:
- Pediatric Allergy and Immunology
- Emergency Medicine
- Clinical Epidemiology
Background:
- Anaphylaxis recurrence in children poses significant health risks.
- Understanding recurrence rates and associated factors is crucial for effective management.
- Previous studies have not fully elucidated recurrence patterns in medically attended pediatric anaphylaxis.
Purpose of the Study:
- To determine the annual recurrence rate of anaphylaxis in children treated in emergency departments.
- To evaluate prehospital and emergency department management of recurrent anaphylaxis.
- To identify factors associated with recurrent anaphylaxis in pediatric patients.
Main Methods:
- Prospective cohort study within the Cross-Canada Anaphylaxis Registry.
- Inclusion of children with medically attended anaphylaxis from 3 emergency departments and emergency medical services.
- Annual follow-up questionnaires and Cox regression analysis to identify recurrence predictors.
Main Results:
- A yearly anaphylaxis recurrence rate of 17.6% was observed in children.
- Food was the trigger in 84.6% of recurrent episodes; epinephrine was used in 66.2% of cases.
- Asthma, food triggers, and epinephrine use during the initial event increased recurrence odds, while peanut triggers decreased them.
Conclusions:
- The study identifies a significant yearly recurrence rate of anaphylaxis in children.
- There is a notable underuse of epinephrine in managing anaphylaxis.
- Educational initiatives are essential to improve avoidance strategies and promote timely epinephrine administration.
Objectives:
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.
Study Design:
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.
Results:
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.
Conclusions:
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.
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