Characteristics Of Anaphylaxis And Management In A Midwestern Hospital System

RATIONALE:

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

METHODS:

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.”

RESULTS:

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.

CONCLUSIONS:

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.