PURPOSE OF THE STUDY.
To identify trends regarding anaphylaxis-related emergency department (ED) visits from 2005 to 2014.
Population data were drawn from OptumLabs Data Warehouse, a national administrative claims database of >100 000 000 pediatric and adult patients in the United States (including those with Medicare Advantage and private insurance) and with a higher representation from the Midwest and the South.
ED visits between 2005 and 2014 were included if patients had medical insurance for at least 30 days before the visit. International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for anaphylactic shock, as well as for symptom combinations consistent with anaphylaxis, were used as inclusion criteria, taking care to avoid duplication. Annual rates were expressed as the number of ED visits per 100 000 enrollees. Linear regressions analysis was used to assess for trends by year.
A total of 56 212 ED visits for anaphylaxis were identified. Most visits were for women (57.5%) between 35 and 64 years of age (42.8%) and were caused by unidentified triggers (56.9%). Overall, 27.1% of visits were associated with food, 12% with medications, and 4% with insect venom reactions. Over the 10-year period, the rate of anaphylaxis-related ED visits increased from 14.2 to 28.6 per 100 000 enrollees (101%). This rate increase was seen across all age groups, with the highest increase in children aged 5 to 17 years (196%). Food-related anaphylaxis increased by 124% overall and by 285% in children aged 5 to 17 years. Medication-related anaphylaxis increased by 212%, with the highest rate of increase in children aged 0 to 4 (479%).
From 2005 to 2014, there was a 101% increase in ED visits for anaphylaxis, with the greatest increase in children <17 and in adults >65 years old. The highest rate increase for both food-related anaphylaxis and anaphylaxis overall was in children aged 5 to 17; for medication-related anaphylaxis, it was in children aged 0 to 4.
This is an eye-opening study whose authors demonstrate the striking and disproportionate increase in the risk (196%) of anaphylaxis in the pediatric population. Although the authors of this retrospective study only used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify anaphylaxis cases, they highlight the need for continued advances in recognition and treatment of pediatric anaphylaxis. Of concern is the dramatically increasing rates of anaphylaxis triggered by foods (5–17 years) and medications (0–4 years), a trend that mirrors the increasing prevalence of food allergy in children and the challenges of diagnosing anaphylaxis in the preschool-aged group.
- Copyright © 2017 by the American Academy of Pediatrics