Clinical Characteristics and Management of Pediatric Egg-Induced Anaphylaxis: A Cross-Sectional Study.

allergy anaphylaxis egg epinephrine

Journal

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
ISSN: 1534-4436
Titre abrégé: Ann Allergy Asthma Immunol
Pays: United States
ID NLM: 9503580

Informations de publication

Date de publication:
16 Mar 2024
Historique:
received: 26 01 2024
revised: 11 03 2024
accepted: 12 03 2024
medline: 19 3 2024
pubmed: 19 3 2024
entrez: 18 3 2024
Statut: aheadofprint

Résumé

Egg is the third most common food allergy in children; however, data on pediatric egg-induced anaphylaxis are sparse. We aimed to describe the clinical characteristics, management, and outcomes of pediatric egg-induced anaphylaxis. Children presenting with anaphylaxis were recruited from 13 emergency departments as part of the Cross-Canada Anaphylaxis Registry (C-CARE), from which data on anaphylaxis triggered by egg were extracted. Multivariate logistic regression was used to determine factors associated with pre-hospital epinephrine autoinjector (EAI) use and to compare anaphylaxis triggered by egg to other triggers of food-induced anaphylaxis (FIA). We recruited 302 children with egg-induced anaphylaxis. The mean age was 2.6 years (Standard deviation=3.6) and 55.3% were male. Only 39.4% had previously been diagnosed with an egg allergy. Pre-hospital EAI use was 32.1%, but this was not significantly lower than in other triggers of FIA (P=0.26). Only 1.4% of patients required hospital admission. Relative to other triggers of FIA, patients with egg-induced anaphylaxis were significantly younger (P<0.001) and exhibited more vomiting (P=0.0053) and less throat tightness (P=0.0015) and angioedema (P<0.001). To our knowledge, this is the largest published cohort of pediatric egg-induced anaphylaxis. In this cohort, pre-hospital EAI use was very low. Additionally, we identified certain symptoms that distinguish egg-induced from other triggers of FIA. Taken together, high suspicion is crucial in identifying egg-induced anaphylaxis, given the younger patient demographic and frequent lack of prior FIA history.

Sections du résumé

BACKGROUND BACKGROUND
Egg is the third most common food allergy in children; however, data on pediatric egg-induced anaphylaxis are sparse.
OBJECTIVE OBJECTIVE
We aimed to describe the clinical characteristics, management, and outcomes of pediatric egg-induced anaphylaxis.
METHODS METHODS
Children presenting with anaphylaxis were recruited from 13 emergency departments as part of the Cross-Canada Anaphylaxis Registry (C-CARE), from which data on anaphylaxis triggered by egg were extracted. Multivariate logistic regression was used to determine factors associated with pre-hospital epinephrine autoinjector (EAI) use and to compare anaphylaxis triggered by egg to other triggers of food-induced anaphylaxis (FIA).
RESULTS RESULTS
We recruited 302 children with egg-induced anaphylaxis. The mean age was 2.6 years (Standard deviation=3.6) and 55.3% were male. Only 39.4% had previously been diagnosed with an egg allergy. Pre-hospital EAI use was 32.1%, but this was not significantly lower than in other triggers of FIA (P=0.26). Only 1.4% of patients required hospital admission. Relative to other triggers of FIA, patients with egg-induced anaphylaxis were significantly younger (P<0.001) and exhibited more vomiting (P=0.0053) and less throat tightness (P=0.0015) and angioedema (P<0.001).
CONCLUSION CONCLUSIONS
To our knowledge, this is the largest published cohort of pediatric egg-induced anaphylaxis. In this cohort, pre-hospital EAI use was very low. Additionally, we identified certain symptoms that distinguish egg-induced from other triggers of FIA. Taken together, high suspicion is crucial in identifying egg-induced anaphylaxis, given the younger patient demographic and frequent lack of prior FIA history.

Identifiants

DOI: 10.1016/j.anai.2024.03.008 PMID: 38499059
pubmed: 38499059
pii: S1081-1206(24)00151-0
doi: 10.1016/j.anai.2024.03.008
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Connor Prosty (C)

Faculty of Medicine, McGill University, Montreal, QC, Canada. Electronic address: onnor.prosty@mail.mcgill.ca.

Moniah Alyasin (M)

Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.

Sofianne Gabrielli (S)

Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.

Ann E Clarke (AE)

Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Judy Morris (J)

Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada.

Jocelyn Gravel (J)

Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada.

Rodrick Lim (R)

Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, ON, Canada.

Edmond S Chan (ES)

Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.

Ran D Goldman (RD)

Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.

Andrew O'Keefe (A)

Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, NL, Canada.

Jennifer Gerdts (J)

Executive Director, Food Allergy Canada, Toronto, ON, Canada.

Derek K Chu (DK)

Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.

Julia Upton (J)

Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada.

Elana Hochstadter (E)

Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

Jocelyn Moisan (J)

Regional Medical Director of Emergency Medical Services of Outaouais, Outaouais, QC, Canada.

Adam Bretholz (A)

Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada.

Christine McCusker (C)

Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.

Xun Zhang (X)

Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada.

Jennifer Lp Protudjer (JL)

Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, MN, Canada.

Elissa M Abrams (EM)

Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MN, Canada.

Elinor Simons (E)

Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MN, Canada.

Moshe Ben-Shoshan (M)

Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.

Classifications MeSH