Incidence and clinical management of paediatric emergency presentations of anaphylaxis in Alberta

Anaphylaxis represents a growing burden on emergency services worldwide; however, long-term paediatric trends are poorly understood. This study examined the incidence, clinical features, management, and outcomes of paediatric emergency department (ED) presentations for anaphylaxis in a western Canadian province and forecasted future visit rates.

This population-based retrospective cohort study used linked administrative health data for all paediatric (<18 years) ED presentations for anaphylaxis in Alberta, between 2004 and 2024. Temporal trends were assessed with time-series models and logistic regression identified factors for hospitalization.

Over the study period, 11,012 anaphylaxis visits were identified (median age 8 years [IQR, 3 to 14]; 57.9% male). Food was the most common trigger (71.1%), although nearly 1 in 4 had no clear cause. The incidence of anaphylaxis ED visits quadrupled, from ∼25 per 100,000 in 2004/05 to 113 per 100,000 in 2023/24, with forecasts projecting a continued rise. Epinephrine was administered in 41.9% of ED encounters and 19.5% of ambulance transports. Hospitalization was infrequent (3.7%); however, it was significantly associated with higher triage acuity (aOR = 1.45; 95% CI: 1.10 to 1.90), higher comorbidity scores (aOR = 1.31; 95% CI: 1.17 to 1.48), and drug-related triggers (aOR = 2.45; 95% CI: 1.60 to 3.75). Females had a significantly higher and earlier risk of 30-day ED revisit for anaphylaxis (P < 0.001).

Paediatric presentations to Alberta EDs for anaphylaxis have quadrupled and are forecasted to continue increasing. First-line epinephrine is severely underutilized, especially prehospital. Further studies are needed to identify factors underlying the observed sex differences and upward trajectories and bridge potential system and policy gaps in "Epi-Care."