Anaphylaxis treated in a Canadian pediatric hospital: Incidence, clinical characteristics, triggers, and management

Ben‐Shoshan, Moshe; Vieille, Sébastien La; Eisman, Harley; Alizadehfar, Reza; Mill, Christopher; Perkins, Emma; Joseph, Lawrence; Morris, Judy; Clarke, Ann E.

doi:10.1016/j.jaci.2013.06.016

Cited by 50 publications

(51 citation statements)

References 12 publications

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“…Similar to our studies in pediatric and adult EDs, food was the main trigger [7,8]. However, in our EMS study, food was suspected to trigger 32.7% of reactions, whereas in the pediatric ED, it triggered 86.9% of reactions (difference: À51.2% [95%CI, À62.6%, À39.9%]) and in the adult ED, food triggered 63.7% of reactions (difference: À30.6% [95% CI, À44.7%, À16.5%]).…”

Section: Discussionsupporting

confidence: 88%

“…We recently reported on anaphylaxis in pediatric and adult EDs in Quebec [7,8]. Our results revealed that almost 0.3% of all pediatric and adult ED visits were due to anaphylaxis and that the majority of the cases were food induced [7,8].…”

Section: Introductionmentioning

confidence: 68%

“…In addition, we were not able to confirm the suspected culprit as we did not have access to allergy testing that may have been performed. However, in our study at the Montreal Children's Hospital using the identical questionnaire, we found that in about 90% of the cases, the reported culprit was confirmed by either skin prick testing, measurement of allergen-specific IgE, or allergen challenge [7]. Our sample size is relatively small and hence more conclusive associations could not be determined.…”

mentioning

confidence: 65%

“…Our results revealed that almost 0.3% of all pediatric and adult ED visits were due to anaphylaxis and that the majority of the cases were food induced [7,8]. We also noted underuse of epinephrine, especially in mild and moderate cases, and in adults [7,8]. To broaden our understanding of anaphylaxis in other settings, we extended C-CARE to evaluate cases of anaphylaxis presenting to the EMS in the Outaouais region of Quebec, Canada.…”

Section: Introductionmentioning

confidence: 85%

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Anaphylaxis Cases Presenting To Primary Care Paramedics In Quebec

Kimchi

Clarke

Moisan

et al. 2014

Journal of Allergy and Clinical Immunology

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Data on anaphylaxis cases in pre-hospital settings is limited. As part of the Cross Canada Anaphylaxis Registry (C-CARE), we assessed anaphylaxis cases managed by paramedics in Outaouais, Quebec. A software program was developed to prospectively record demographic and clinical characteristics as well as management of cases meeting the definition of the anaphylaxis. Univariate and multivariate logistic regressions were compared to assess factors associated with severity of reactions and epinephrine use. 1.5, 12.0], respectively). This is the first prospective study evaluating anaphylaxis managed by paramedics. Anaphylaxis accounts for a substantial proportion of the cases managed by paramedics in Outaouais, Quebec and exceeds prior reports of the proportion of Quebec emergency room visits attributed to anaphylaxis. Although guidelines recommend prompt use of epinephrine for all cases of anaphylaxis, more than a third of cases did not receive epinephrine. It is crucial to develop educational programs targeting paramedics to promote the use of epinephrine in all cases of anaphylaxis regardless of the specific trigger.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 68%

mentioning

confidence: 65%

Section: Introductionmentioning

confidence: 85%

See 2 more Smart Citations

Anaphylaxis Cases Presenting To Primary Care Paramedics In Quebec

Kimchi

Clarke

Moisan

et al. 2014

Journal of Allergy and Clinical Immunology

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“…Up to 50% of anaphylactic reactions to milk are due to accidental exposure in individuals who are known to have milk allergy [8]. Appropriate diagnosis and prompt management of milk allergy is crucial.…”

Section: Discussion Of Case and Literature Reviewmentioning

confidence: 99%

Anaphylaxis to Baked Milk: A Case Presentation and Review of Literature

O’Keefe¹

2014

Emergency Medicine

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Anaphylaxis cases presenting to primary care paramedics in Quebec

Kimchi

Clarke

Moisan

et al. 2015

Immunity Inflam & Disease

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Data on anaphylaxis cases in pre‐hospital settings is limited. As part of the Cross Canada Anaphylaxis Registry (C‐CARE), we assessed anaphylaxis cases managed by paramedics in Outaouais, Quebec. A software program was developed to prospectively record demographic and clinical characteristics as well as management of cases meeting the definition of the anaphylaxis. Univariate and multivariate logistic regressions were compared to assess factors associated with severity of reactions and epinephrine use. Among 33,788 ambulance calls of which 23,486 required transport, 104 anaphylaxis cases were identified (anaphylaxis rate of 0.31% [95%CI, 0.25%, 0.37%] among all ambulance calls and 0.44% [95%CI, 0.36%, 0.54%] among those requiring transport). The median age was 46.8 years and 41.3% were males. The common triggers included food (32.7% [95%CI, 24.0%, 42.7%]), drugs (24.0% [16.4%, 33.6%]), and venom (17.3% [10.8%, 26.2%]). Among all reactions, 37.5% (95%CI, 28.4%, 47.6%) were severe. Epinephrine was not administered in 35.6% (95%CI, 26.6%, 45.6%) of all cases. Males were more likely to have severe reactions (Odds ratio [OR]: 2.50 [95%CI, 1.03, 6.01]). Venom‐induced reactions and severe anaphylaxis were more likely to be managed with epinephrine (OR: 6.9 [95%CI, 1.3, 35.3] and 4.2 [95%CI, 1.5, 12.0], respectively). This is the first prospective study evaluating anaphylaxis managed by paramedics. Anaphylaxis accounts for a substantial proportion of the cases managed by paramedics in Outaouais, Quebec and exceeds prior reports of the proportion of Quebec emergency room visits attributed to anaphylaxis. Although guidelines recommend prompt use of epinephrine for all cases of anaphylaxis, more than a third of cases did not receive epinephrine. It is crucial to develop educational programs targeting paramedics to promote the use of epinephrine in all cases of anaphylaxis regardless of the specific trigger.

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Anaphylaxis treated in a Canadian pediatric hospital: Incidence, clinical characteristics, triggers, and management

Cited by 50 publications

References 12 publications

Anaphylaxis Cases Presenting To Primary Care Paramedics In Quebec

Anaphylaxis Cases Presenting To Primary Care Paramedics In Quebec

Anaphylaxis to Baked Milk: A Case Presentation and Review of Literature

Anaphylaxis cases presenting to primary care paramedics in Quebec

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