PURPOSE OF THE STUDY.
To prospectively evaluate the risk and management of recurrent anaphylaxis in children and assess factors associated with recurrences.
The study included 292 children who were treated for anaphylaxis at participating Canadian emergency departments.
Patients were prospectively recruited at presentation for an index anaphylactic reaction. Anaphylaxis was defined as a reaction involving at least 2 organ systems and/or hypotension in response to a potential allergen and was diagnosed by the treating physician. A 12-item survey was given to the care provider in which baseline characteristics of demographics, medical history, clinical characteristics of the reaction, and management of the index case were evaluated. Parents were then contacted via telephone at approximately yearly intervals for 2 years and given a questionnaire in which the potential for allergic reactions and their triggers, symptoms, and management were evaluated.
Of the 292 patients, 69% completed at least 1 annual follow-up questionnaire, providing 369 patient-years of follow-up. The characteristics of those who responded and those who did not were overall similar, with the exception that those who responded were more likely to have a history of eczema. There were 65 recurrent episodes of anaphylaxis among 47 patients in the follow-up period, with an annual recurrence rate of 17.6%. Foods were the most common trigger, leading to 85% of recurrent reactions. Of these reactions, milk and tree nuts were the most common (15% each), followed by peanuts (6%). Factors associated with increased odds of recurrence included history of asthma, use of epinephrine during the index episode, and food-triggered anaphylaxis at index reaction. Consistent with many other studies, there was an underuse of epinephrine in treating both the index and recurrent episodes of anaphylaxis.
The authors of this study found the recurrence rate of anaphylaxis in children to be 17.6%, and the odds of recurrence increased with a history of asthma and food-induced anaphylaxis. Furthermore, there was a significant underuse of epinephrine in managing anaphylaxis.
This study is the largest prospective study thus far in which rates of recurrent anaphylaxis and associated factors in children were evaluated. The recurrence rate observed underscores the importance of long-term, effective patient education in identifying signs, symptoms, and management of anaphylaxis. Furthermore, the authors of this study highlight the well-established underuse of epinephrine in managing anaphylaxis and continue the call for improving epinephrine education.
- Copyright © 2017 by the American Academy of Pediatrics