492:
Cross-Canada Anaphylaxis Registry (C-CARE): comparing rates, triggers, and management of anaphylaxis in a single centre emergency department (ED) over 4 years.
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Juan C. Ruiz, MD, Victoria Zotova, MD, Moshe Ben-Shoshan, MD, MSc, Hamna Tariq, Medical Student, Taylor Sheppard, Medical Student, Yuka Asai, MD, MSc, FRCPC, Adil Adatia, Yarden Yanishevsky, MD, MRCPI, FACAAI, FAAAAI, Edmond S. Chan, MD, FRCPC, Greg Shand, BSc, MSc, Ricky Chin, Ann Elaine Clarke, MD, MSc
RATIONALE:

To compare rates, triggers, and management of anaphylaxis in an ED in Calgary, Alberta between 2011 and 2015.

METHODS:

As part of the Cross-Canada Anaphylaxis Registry (C-CARE), anaphylaxis cases fulfilling the consensus definition were identified through chart review of adults presenting with anaphylaxis and allergy-related ICD-10 codes.

RESULTS:

In 2011, 0.16% (95%CI 0.13-0.19) of ED presentations were due to anaphylaxis. The most common triggers were food [54.5% (95%CI 45.2-63.6)] and drugs [17.4% (95%CI 11.1-25.3)]. Among food-induced cases, peanuts triggered 19.7% (95%CI 10.9-31.3), tree nuts 16.7% (95%CI 8.6-27.9), and shellfish 12.1% (95%CI 5.4-22.5). 63.6% (95%CI 54.4-72.2) of cases received epinephrine; 26.4% (95%CI 18.8-35.2) as an outpatient only, 28.9% (95%CI 21.0-37.9) as an inpatient only, and 8.3 % (95%CI 4-14.7%) as both an outpatient and inpatient. 86.0% (95%CI 78.5-91.6) of reactions were moderate/severe.

In 2015, 0.14% (95%CI 0.12-0.17) of ED presentations were due to anaphylaxis. The most common triggers were food [63.4% (95%CI 53.8-72.3)] and drugs [14.3% (95% CI 7.0-20.1)]. Among food-induced cases, peanuts triggered 22.5% (95%CI 13.5-34.0), tree nuts 16.9% (95%CI 9.1-27.7), and shellfish 8.5% (95%CI 3.2-17.5). 81.3% (95%CI 72.8-88.0) received epinephrine; 27.7% (95%CI 19.6-36.9) as an outpatient only, 42.0% (95%CI 32.7-51.7) as an inpatient only, and 11.6 (95%CI 6.3-19.0) as both an outpatient and inpatient. 86.6% (95%CI 78.9-92.3) were moderate/severe.

CONCLUSIONS:

Anaphylaxis rates, triggers, and severity did not differ. A higher proportion were treated with epinephrine in 2015 [difference 17.6% (95% CI 6.4-28.8)], primarily due to increased inpatient usage [difference 13.0% (95% CI 0.84-25.2)], likely reflecting increased physician awareness.