Outcomes and Factors Associated With Prehospital Treatment of Pediatric Anaphylaxis.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
01 Jan 2022
01 Jan 2022
Historique:
pubmed:
17
6
2020
medline:
8
1
2022
entrez:
17
6
2020
Statut:
ppublish
Résumé
Anaphylaxis is a potentially life-threatening reaction requiring prompt treatment with intramuscular epinephrine (EPI). We sought to describe presenting features of pediatric anaphylaxis and compare patient characteristics and outcomes of children treated with prehospital EPI with those untreated. We abstracted data from emergency department (ED) records for children meeting the National Institute of Allergy & Infectious Disease criteria for anaphylaxis (2015-2017) in one tertiary care children's hospital. We analyzed associations between patient characteristics and outcomes and receipt of prehospital EPI using descriptive statistics and multivariate logistic regression. Of 414 children presenting with anaphylaxis, 39.4% received IM EPI and 62.1% received antihistamines before hospital arrival. Children with Medicaid received pre-emergency department EPI less frequently than did children with private insurance (24.5% vs 43.8%, P = 0.001). Factors positively associated with prehospital EPI administration were history of food allergy (odds ratio [OR], 4.4 [95% confidence interval {CI}, 2.4-8.2]) or arrival by emergency medical services (OR, 8.0 [95% CI, 4.2-15.0]). Medicaid insurance was associated with decreased odds of prehospital EPI (OR, 0.33 [95% CI, 0.16-0.66]) and prehospital H1-antihistamine use (OR, 0.30 [95% CI, 0.17-0.56]). Prehospital EPI treatment was also associated with decreased rates of observation (37% vs 63%), inpatient admission (38% vs 62%), and intensive care unit admission (20% vs 80%) compared with no pretreatment (P = 0.03). Prehospital treatment with EPI remains low, and barriers to optimal treatment are more pronounced in children with public insurance. Prehospital treatment with EPI was associated with decreased morbidity including hospitalization and intensive care unit admission.
Identifiants
pubmed: 32544141
pii: 00006565-202201000-00031
doi: 10.1097/PEC.0000000000002146
doi:
Substances chimiques
Epinephrine
YKH834O4BH
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e69-e74Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: The authors declare no conflict of interest.
Références
Lin RY, Anderson AS, Shah SN, et al. Increasing anaphylaxis hospitalizations in the first 2 decades of life: New York State, 1990–2006. Ann Allergy Asthma Immunol . 2008;101:387–393.
Michelson KA, Monuteaux MC, Neuman MI. Variation and trends in anaphylaxis care in United States children's hospitals. Acad Emerg Med . 2016;23:623–627.
Hochstadter E, Clarke A, De Schryver S, et al. Increasing visits for anaphylaxis and the benefits of early epinephrine administration: a 4-year study at a pediatric emergency department in Montreal, Canada. J Allergy Clin Immunol . 2016;137:1888–1890.e4.
Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics . 2011;128:e9–e17.
Lieberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol . 2010;126:477–480.e471–442.
Song TT, Worm M, Lieberman P. Anaphylaxis treatment: current barriers to adrenaline auto-injector use. Allergy . 2014;69:983–991.
Prince BT, Mikhail I, Stukus DR. Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities. J Asthma Allergy . 2018;11:143–151.
Chad L, Ben-Shoshan M, Asai Y, et al. A majority of parents of children with peanut allergy fear using the epinephrine auto-injector. Allergy . 2013;68:1605–1609.
Huang F, Chawla K, Jarvinen KM, et al. Anaphylaxis in a New York City pediatric emergency department: triggers, treatments, and outcomes. J Allergy Clin Immunol . 2012;129:162–168.e161–163.
Hannaway PJ, Connelly ME, Cobbett RM, et al. Differences in race, ethnicity, and socioeconomic status in schoolchildren dispensed injectable epinephrine in 3 Massachusetts school districts. Ann Allergy Asthma Immunol . 2005;95:143–148.
Cristiano LM, Hiestand B, Caldwell JW, et al. Prehospital administration of epinephrine in pediatric anaphylaxis—a statewide perspective. Prehosp Emerg Care . 2018;22:452–456.
Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol . 2006;117:391–397.
Robinson M, Greenhawt M, Stukus DR. Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department. Ann Allergy Asthma Immunol . 2017;119:164–169.
Fleming JT, Clark S, Camargo CA Jr., et al. Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization. J Allergy Clin Immunol Pract . 2015;3:57–62.
Dyer AA, Lau CH, Smith TL, et al. Pediatric emergency department visits and hospitalizations due to food-induced anaphylaxis in Illinois. Ann Allergy Asthma Immunol . 2015;115:56–62.
Bilaver LA, Kester KM, Smith BM, et al. Socioeconomic disparities in the economic impact of childhood food allergy. Pediatrics . 2016;137:e20153678.
Campbell RL, Li JT, Nicklas RA, et al. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol . 2014;113:599–608.
Sicherer SH, Simons FER, Section On A. Immunology. Epinephrine for first-aid management of anaphylaxis. Pediatrics . 2017;139:e20164006.
Chooniedass R, Temple B, Becker A. Epinephrine use for anaphylaxis: too seldom, too late: current practices and guidelines in health care. Ann Allergy Asthma Immunol . 2017;119:108–110.
Arroabarren E, Lasa EM, Olaciregui I, et al. Improving anaphylaxis management in a pediatric emergency department. Pediatr Allergy Immunol . 2011;22:708–714.
Sampson HA. Fatal food-induced anaphylaxis. Allergy . 1998;53:125–130.
Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med . 1992;327:380–384.
Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol . 2007;119:1016–1018.
Russell S, Monroe K, Losek JD. Anaphylaxis management in the pediatric emergency department: opportunities for improvement. Pediatr Emerg Care . 2010;26:71–76.
Lee S, Bellolio MF, Hess EP, et al. Time of onset and predictors of biphasic anaphylactic reactions: a systematic review and meta-analysis. J Allergy Clin Immunol Pract . 2015;3:408–416.e401–402.
Grossman SL, Baumann BM, Garcia Pena BM, et al. Anaphylaxis knowledge and practice preferences of pediatric emergency medicine physicians: a national survey. J Pediatr . 2013;163:841–846.
Liyanage CK, Galappatthy P, Seneviratne SL. Corticosteroids in management of anaphylaxis; a systematic review of evidence. Eur Ann Allergy Clin Immunol . 2017;49:196–207.
Alqurashi W, Ellis AK. Do corticosteroids prevent biphasic anaphylaxis? J Allergy Clin Immunol Pract . 2017;5:1194–1205.
Emergency Epinephrine Act. Public Act 97-0361 2011.
Zadikoff EH, Whyte SA, DeSantiago-Cardenas L, et al. The development and implementation of the Chicago public schools emergency EpiPen® policy. J School Health . 2014;84:342–347.
McIntyre CL, Sheetz AH, Carroll CR, et al. Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics . 2005;116:1134–1140.