Cross-Canada Anaphylaxis Registry (C-CARE): comparing rates, triggers, and management of anaphylaxis in a single centre emergency department (ED) over 4 years.

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.