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RATIONALE: Studies suggest that food allergy and anaphylaxis are increasing and that fatality may occur outside the home. No large scale prospective studies have assessed the management of anaphylaxis in restaurants. Our goal was to evaluate clinical characteristics and management of anaphylaxis occurring in restaurants. METHODS: We used the Cross-Canada Anaphylaxis Registry, a cohort study established in 2011 enrolling anaphylaxis cases at emergency departments in 5 provinces. Participants were recruited prospectively and retrospectively, and met the definition of anaphylaxis, as defined by the position paper of the European Academy of Allergy and Clinical Immunology on the management of anaphylaxis in childhood. We collected data on sociodemographic factors, clinical characteristics, reaction location, and management based on a standardized questionnaire. Only reactions occurring in restaurants were included in our analysis. Factors associated with epinephrine use were identified using logistic regression. RESULTS: Of the 695 participants, 144 anaphylaxis cases occurred in a restaurant, including 114 (79.2%) children. Outpatient epinephrine use was low (38.2%), even among those with known food allergies (48%), and more likely in cases with known food allergy (OR 1.37; 95% CI 1.16-1.62), moderate reactions (OR 1.22; 95% CI 1.02-1.47), and peanut-triggered reactions (OR 1.37; 95% CI 1.16-1.61). Reactions occurred most commonly to peanut (18.4% of known triggers). CONCLUSIONS: Outpatient epinephrine use was low among participants who suffered anaphylaxis in a restaurant. There is a need for educational programs promoting epinephrine use and allergen avoidance for restaurant staff and patrons. Policies encouraging restaurants to learn how to use and to stock epinephrine auto-injectors are required.

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