Characteristics Of Anaphylaxis And Management In A Midwestern Hospital System
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Julia S. Lee, MD, Manoj Warrier, MD FAAAAI

This study examined characteristics of pediatric anaphylaxis as documented by emergency departments (EDs) of five hospitals in a Midwestern hospital system.


We reviewed electronic medical charts from SSMHealth EDs over a six month period to assess documentation of anaphylaxis events. Approximately 740 electronic medical charts had relevant ICD 10 codes and 60 records of patients 0-20 years old met the criteria for anaphylaxis per “Anaphylaxis- a practice parameter update 2015.”


Thirty-five percent of patients had asthma, 16.7% had rhinitis, 28.3% had atopic dermatitis, and 55% had food allergies. The most common triggers were tree nuts (25%), peanut (18.3%), finfish (10%), shellfish (6.67%), and milk (5%).The most common reactions included hives (52%), skin swelling (30%), mucosal surface swelling (42%), tingling in mouth (35%), fainting (5%), trouble breathing (67%), throat tightening (37%), cough (35%), abdominal pain (23%), nausea (38%), and vomiting (42%). Management consisted of steroid (78%), epinephrine (31.67%), intravenous fluids (18%), anti-H1 blockers (52%) and anti-H2 blockers (28%). Patients were advised to follow up with their primary provider (37%) and/or an allergist (27%) and 68% of patients were prescribed epinephrine at discharge.


Food allergies were documented as the cause for a majority of pediatric anaphylactic episodes presenting to EDs in a Midwestern hospital system. Epinephrine administration was documented in less than 1/3 of patients, suggesting underutilization of epinephrine in cases of anaphylaxis. Increased collaboration between allergists and ED physicians to develop tools to standardized documentation and care pathways may improve long term outcomes.