The Risk of Recurrent Anaphylaxis

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• 作者：Andrew O'Keefe ; MD¹ ; Ann Clarke ; MD ; MSc² ; Yvan St. Pierre ; MSc³ ; Jennifer Mill ; BA³ ; Yuka Asai ; MD ; MSc⁴ ; Harley Eisman ; MD⁵ ; Sebastien La Vieille ; MD⁶ ; Reza Alizadehfar ; MD³ ; Lawrence Joseph ; PhD³ ; Judy Morris ; MD⁷ ; Jocelyn Gravel ; MD⁸ ; Moshe Ben-Shoshan ; MD ; MSc⁹
• 关键词：anaphylaxis ; food allergy ; epinephrine ; risk
• 刊名：The Journal of Pediatrics
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：180
• 期：Complete
• 页码：217-221
• 全文大小：164 K
• 卷排序：180

文摘

To determine the recurrence rate of anaphylaxis in children medically attended in an emergency department (ED), we performed a prospective cohort study to evaluate prehospital and ED management of children with recurrent anaphylaxis and to assess factors associated with recurrent anaphylaxis.Study designAs part of the Cross-Canada Anaphylaxis Registry, parents of children with anaphylaxis identified prospectively in 3 EDs and through an emergency medical response service were contacted annually after presentation and queried on subsequent reactions. Cox regression analysis determined factors associated with recurrence.ResultsAmong 292 children who were registered as having had medical attended anaphylaxis, 68.5% completed annual follow-up questionnaires. Forty-seven patients experienced 65 episodes of anaphylaxis during 369 patient-years of follow-up. Food was the trigger in 84.6% of cases, and epinephrine was used in 66.2%. In 50.8%, epinephrine was used outside the health care facility, and 81.7% were brought to a health care facility for treatment. Asthma, reaction triggered by food, and use of epinephrine during the index episode increased the odds of recurrent reaction. Patients whose initial reaction was triggered by peanut were less likely to have a recurrent reaction.ConclusionsWe report a yearly anaphylaxis recurrence rate of 17.6% in children. There is substantial underuse of epinephrine in cases of anaphylaxis. Educational programs that promote effective avoidance strategies and prompt use of epinephrine are required.