Characteristics, morbidity, and mortality of anaphylaxis-associated admissions to North American PICUs, 2010-2015
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Nicole B Ramsey, MD PhD, Danielle Guffey, MS, Nana E Coleman, MD EdM, Carla M. Davis, MD FAAAAI
RATIONALE: Anaphylaxis is a rapid-onset, multi-organ system, and potentially fatal hypersensitivity reaction, which has varying reports of incidence and mortality. Characteristics of anaphylaxis among pediatric patients requiring intensive care in North America are underreported. We define epidemiological trends, morbidity and mortality of anaphylaxis among critically ill pediatric patients admitted to pediatric intensive care units (PICUs) in North America from 2010-2015.

METHODS: We evaluated an international database of PICUs, Virtual Pediatrics Systems (VPS), for anaphylaxis admissions—comparing probability of death, mortality, and intubation to age, race, and region.

RESULTS: From 2010-2015 there were 1,989 pediatric anaphylaxis admissions to North American PICUs in the VPS database. Overall probability of death was 0.9% with 1% mortality. Food was the most common specified trigger for anaphylaxis, with peanut as the most prevalent food (45%), followed by tree nuts/seed (19%) and milk (10%). Intubation occurred to 19% of patients. More children ages 6-18 years had anaphylaxis compared to the overall PICU population (p<0.001) and intubation was least common in 2-5 year olds (p=0.037). Asian patients were disproportionately represented (p<0.001). Admissions were most likely to occur during the fall (p=0.002) and in the Northeast and Western regions of the United States. (p<0.001).

CONCLUSIONS: The burden of pediatric anaphylaxis is ~0.2% of all PICU admissions in the North American VPS database. Among these, the case mortality rate was 1%, which did not vary based on demographic factors. This is the largest, comprehensive report of anaphylaxis among pediatric patients requiring intensive care in North America.