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Comparison of Pediatric Anaphylaxis at Montreal Children's Hospital and British Columbia Children's Hospital: Rate, Clinical Characteristics, Triggers and Management
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Alison YM Lee, MD, Paul Enarson, MD, PhD, Ann Clarke, MD, MSc, Sebastian La Vieille, MD, Harley Eisman, MD, Edmond S. Chan, MD FAAAAI, Christopher Mill, BSc, MPH, Lawrence Joseph, PhD, Moshe Ben-Shoshan
Rationale: To compare the rate, triggers and management of anaphylaxis between two Canadian pediatric emergency departments (PEDs).

Methods: As part of the Cross-Canada Anaphylaxis REgistry (C-CARE), children presenting to Montreal Children’s Hospital (MCH) and BC Children’s Hospital (BCCH) PED with anaphylaxis were recruited. Characteristics, triggers and management of anaphylaxis were documented using a standardized data entry form.  The differences in demographics, triggers, pre-hospital and in-hospital management were determined.

Results: Between June 2014–2015, 148 of 46,321 cases to the BCCH PED were of anaphylaxis, a rate of 0.32%(95%CI,0.27%,0.38%), similar to MCH’s rate of 0.38%(0.34%,0.42%) from 321 of 83,684 cases.  There were no substantial differences in demographics (age, sex) nor preexisting asthma. However, known eczema and food allergy were more commonly reported at BCCH than MCH (9.5%[5.5%,15.7%] vs 2.5%[1.2%,5.0%], and 63.5%[55.2%,71.2%] vs 49.5%[43.9%, 55.1%] respectively).  In both centers the majority of cases were triggered by food (BCCH 87.8%[81.2%,92.4%], MCH 83.5%[78.9,87.3]), of which peanuts were the most common culprit (23.8%[17%,32.3%] and 20.1%[15.6%,25.6%] respectively).  Distribution of anaphylaxis severity was comparable between centers.  Pre-hospital treatment was similar in epinephrine administration (BCCH 28.4%[21.4%,36.5%], MCH 35.2%[30.0%,40.7%]); however, more antihistamine was given in BC (59.5%[51.1%,67.4%]) than Montreal (45.2%[39.7%,50.8%]).  In-hospital management differed in terms of increased epinephrine, antihistamine, and steroid use at BCCH (56.4%[47.7%,64.1%], 60.1%[51.7%,68%] and 70.9% [62.8%,78.0%] respectively) compared to MCH (41.4% [36.0%,47.0%], 38.6%[33.3%,44.2%] and 10.6%[7.5%,14.6%] respectively).

Conclusions: There are substantial differences in co-morbid conditions and management practices in pediatric anaphylaxis across Canadian Centers. It is crucial to develop training programs that aim to increase epinephrine use in anaphylaxis cases.