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.

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PURPOSE OF THE STUDY. To evaluate any associations between the introduction of cow's milk products/other solid food products and infant atopic manifestations in the second year of life.