Background Anaphylaxis incidence is increasing. Objective To characterize anaphylaxis in children in an urban pediatric emergency department (PED). Methods Review of PED records for anaphylactic reactions over 5 years. Results We identified 213 anaphylactic reactions in 192 children (97 males); 6 were infants; 20 had multiple reactions; median age 8 years; range 4 mo-18 yr. Sixty-two reactions were coded as anaphylaxis; 151 additional reactions met the Second symposium anaphylaxis criteria. There was no increase in incidence over 5 years. The triggers included: foods, 71%; unknown, 15%; drugs, 9%, and other, 5%. Food was more likely to be a trigger in multiple PED visits, P=.03. Epinephrine was administered in 169 (79%) reactions; in 58 (27%) epinephrine was given before arrival in PED. Patients with Medicaid were less likely to receive epinephrine before arrival in PED, P<.001. Twenty-eight (14.6%) patients were hospitalized; 9 in the intensive care unit. For thirteen (6%) of the reactions, two doses of epinephrine were administered; 69% of patients treated with two doses of epinephrine were hospitalized, compared to 12% of patients treated with a single dose, P<.001. Administration of both epinephrine doses before arrival to PED was associated with a lower rate of hospitalization compared to epinephrine administration in the PED, P=.05. Conclusions Food is the main anaphylaxis trigger in the urban PED, although the ICD-9 code for anaphylaxis is underutilized. Treatment with two doses of epinephrine is associated with a higher risk of hospitalization; epinephrine treatment before arrival to PED is associated with a decreased risk. Children with Medicaid are less likely to receive epinephrine before arrival in PED.

Heating has a different effect on whey and caseins in cow's milk and ovalbumin and ovomucoid in hen's egg white. The effect of heat on protein allergenicity is affected by the temperature and duration, along with the presence of wheat.

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An oral challenge to extensively heated milk and egg into milk and egg allergic children's diets should be considered when appropriate. Oral food challenges are the most reliable means of establishing a diagnosis and should be undertaken under physician supervision.