Impact of Reaction Setting on the Management, Severity, and Outcome of Pediatric Food-Induced Anaphylaxis: A Cross-Sectional Study,The Journal of Allergy and Clinical Immunology: In Practice

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Impact of Reaction Setting on the Management, Severity, and Outcome of Pediatric Food-Induced Anaphylaxis: A Cross-Sectional Study
The Journal of Allergy and Clinical Immunology: In Practice ( IF 8.2 ) Pub Date : 2022-09-23 , DOI: 10.1016/j.jaip.2022.09.015
Connor Prosty ₁ , Marina Delli Colli ₁ , Sofianne Gabrielli ₁ , Ann E Clarke ₂ , Judy Morris ₃ , Jocelyn Gravel ₄ , Rodrick Lim ₅ , Edmond S Chan ₆ , Ran D Goldman ₇ , Andrew O'Keefe ₈ , Jennifer Gerdts ₉ , Derek K Chu ₁₀ , Julia Upton ₁₁ , Elana Hochstadter ₁₁ , Adam Bretholz ₁₂ , Christine McCusker ₁ , Xun Zhang ₁₃ , Jennifer L P Protudjer ₁₄ , Moshe Ben-Shoshan ₁

Affiliation

Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, Quebec, Canada.
Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Emergency Medicine, Hôpital Sacré-Coeur, Montréal, Quebec, Canada.
Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.
Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ont, Canada.
Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, and the BC Children's Research Institute, University of British Columbia, Vancouver, BC, Canada.
Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
Food Allergy Canada, Toronto, Ont, Canada.
Division of Clinical Immunology and Allergy, Department of Medicine, and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont, Canada.
Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ont, Canada.
Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montréal, Quebec, Canada.
Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Man, Canada; Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Man, Canada; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.

Background

Prompt epinephrine autoinjector (EAI) use is the primary treatment for anaphylaxis. However, limited Canadian data exist on the impact of reaction location on EAI use for food-induced anaphylaxis (FIA).

Objective

We sought to investigate the setting, management, and severity of pediatric FIA.

Methods

We recruited children presenting with FIA from 11 Canadian emergency departments. Patient demographics and the setting, management, and symptoms of FIA were collected by standardized questionnaire. Factors associated with prehospital EAI use and reaction severity were determined by logistic regression.

Results

We recruited 3,604 children; 60.2% were male and the median age was 5.0 years (interquartile range 1.8–11.0). Among cases with a known location of FIA (85.0%), home was the most common setting (68.1%), followed by school/daycare (12.8%), other locations (11.4%; eg, park, car), and restaurants (7.4%). In the prehospital setting, EAI was administered in 36.7% of reactions at home, 66.7% in school/daycare, 40.2% in other locations, and 44.5% in restaurants. Relative to reactions occurring at school/daycare, prehospital EAI use was less likely at home (adjusted odds ratio [aOR] 0.80; 95% CI 0.76–0.84), in restaurants (aOR 0.81; 95% CI 0.75–0.87), and in other settings (aOR 0.77; 95% CI 0.73–0.83), when data were adjusted for reaction severity, sex, age, comorbidities, and province. The FIA setting was not associated with reaction severity or hospitalization.

Conclusions

Prehospital EAI use was higher at school/daycare than in other settings, potentially owing to the presence of policies and training on FIA. Setting-specific interventions including educational programs and policies/laws mandating training and stocking an EAI may improve anaphylaxis recognition and treatment.

中文翻译：

反应设置对儿科食物引起的过敏反应的管理、严重程度和结果的影响：一项横断面研究

背景

及时使用肾上腺素自动注射器(EAI) 是过敏反应的主要治疗方法。然而，关于反应位置对 EAI 用于食物引起的过敏反应 (FIA) 的影响的加拿大数据有限。

客观的

我们试图调查儿科 FIA 的背景、管理和严重程度。

方法

我们从 11 个加拿大急诊部门招募了患有 FIA 的儿童。通过标准化问卷收集患者的人口统计资料以及 FIA 的背景、管理和症状。通过逻辑回归确定与院前 EAI 使用和反应严重程度相关的因素。

结果

我们招募了 3,604 名儿童；60.2% 为男性，中位年龄为 5.0 岁（四分位间距 1.8-11.0）。在已知 FIA 位置 (85.0%) 的病例中，家庭是最常见的环境 (68.1%)，其次是学校/日托 (12.8%)、其他位置 (11.4%；例如，公园、汽车) 和餐馆 ( 7.4%）。在院前环境中，EAI 用于 36.7% 的家庭反应、66.7% 的学校/日托中心、40.2% 的其他地点和 44.5% 的餐厅。相对于在学校/日托所发生的反应，院前使用 EAI 在家中（调整后的比值比 [aOR] 0.80；95% CI 0.76–0.84）、餐厅（aOR 0.81；95% CI 0.75–0.87）和在其他设置（aOR 0.77；95% CI 0.73–0.83），当根据反应严重程度、性别、年龄、合并症和省份调整数据时。