Table 2.
Characteristics of children admitted to the hospital with food-induced anaphylaxis, according to significant inpatient intervention.*
| No intervention (n=84) | Received intervention (n=16) | P value | |||
|---|---|---|---|---|---|
| Demographic characteristics | |||||
| Age, median (IQR) | 2.6 (1.3 – 9.5) | 8.4 (5.5 – 15.0) | 0.01 | ||
| Male (%) | 55 (65%) | 12 (75%) | 0.57 | ||
| White race (%) | 66 (79%) | 8 (50%) | 0.03 | ||
| Medical history | |||||
| Known allergy to offending allergen (%) | 33 (39%) | 11 (69%) | 0.052 | ||
| Known allergic problems (%) | 62 (74%) | 15 (94%) | 0.11 | ||
| Prior allergic reaction to other sources (%) | 24 (39%) | 9 (60%) | 0.16 | ||
| Asthma (%) | 26 (42%) | 13 (87%) | 0.003 | ||
| Hayfever (%) | 15 (24%) | 6 (40%) | 0.33 | ||
| Atopic dermatitis (%) | 27 (44%) | 3 (20%) | 0.14 | ||
| Hives (%) | 1 (2%) | 0 (0%) | 1.00 | ||
| Angioedema (%) | 0 (0%) | 0 (0%) | -- | ||
| Other (%) | 3 (5%) | 0 (0%) | 1.00 | ||
| Patient owns self-injectable (%) (n=7 missing) | 30 (37%) | 9 (75%) | 0.03 | ||
| Other chronic medical problems (%) | 18 (21%) | 6 (38%) | 0.20 | ||
| Chronic medications (%) | 39 (46%) | 12 (75%) | 0.06 | ||
| Current Reaction | |||||
| Specific food trigger causing current reaction | |||||
| Peanuts (%) | 27 (32%) | 4 (25%) | 0.77 | ||
| Tree nuts (%) | 27 (32%) | 1 (6%) | 0.04 | ||
| Seeds (%) | 0 (0%) | 0 (0%) | -- | ||
| Fruits and vegetables (%) | 2 (2%) | 0 (0%) | 1.00 | ||
| Shellfish (%) | 3 (4%) | 3 (19%) | 0.050 | ||
| Fish (%) | 0 (0%) | 1 (6%) | 0.16 | ||
| Milk products (%) | 16 (19%) | 4 (25%) | 0.73 | ||
| Eggs (%) | 6 (7%) | 0 (0%) | 0.59 | ||
| Wheat (%) | 0 (0%) | 0 (0%) | -- | ||
| Other food (%) | 9 (11%) | 3 (19%) | 0.40 | ||
| Location of exposure (%) (n=7 missing) | 0.67 | ||||
| Home | 53 (66%) | 8 (62%) | |||
| School/daycare | 6 (8%) | 1 (8%) | |||
| Restaurant | 2 (3%) | 1 (8%) | |||
| Other | 19 (24%) | 3 (23%) | |||
| Symptom onset (%) (n=20 missing) | 1.00 | ||||
| <1 hr | 30 (44%) | 5 (42%) | |||
| 1-3 hrs | 29(43%) | 6(50%) | |||
| 4-6 hrs | 5 (7%) | 0 (0%) | |||
| 7-12 hrs | 0 (0%) | 0 (0%) | |||
| >12 hrs | 4 (6%) | 1 (8%) | |||
| Route of exposure | |||||
| Oral (%) | 84 (100%) | 15 (94%) | 0.16 | ||
| Skin contact (%) | 1 (1%) | 0 (0%) | 1.00 | ||
| Inhalation (%) | 0 (0%) | 1 (6%) | 0.16 | ||
| Other (%) | 0 (0%) | 0 (0%) | -- | ||
| Prehospital/ED organ systems involved in allergic reaction | |||||
| Respiratory (%) | 67 (80%) | 16 (100%) | 0.07 | ||
| Cutaneous (%) | 82 (98%) | 15 (94%) | 0.41 | ||
| Gastrointestinal (%) | 55 (65%) | 15 (94%) | 0.03 | ||
| Cardiovascular (%) | 9 (11%) | 1 (6%) | 1.00 | ||
| Other (%) | 15 (18%) | 3 (19%) | 1.00 | ||
| Treatments | |||||
| Pre-ED treatments | |||||
| Diphenhydramine (%) | 49 (78%) | 10 (71%) | 0.73 | ||
| Other antihistamines (%) | 2 (3%) | 1 (7%) | 0.46 | ||
| Steroids (%) | 12 (19%) | 5 (36%) | 0.28 | ||
| Intravenous fluids (%) | 3 (5%) | 0 (0%) | 1.00 | ||
| Inhaled Beta-agonists (%) | 10 (16%) | 5 (36%) | 0.13 | ||
| Oxygen (%) | 9 (14%) | 1 (7%) | 0.68 | ||
| Number pre-ED epinephrine doses (%) | 0.30 | ||||
| 0 | 50 (60%) | 6 (38%) | |||
| 1 | 31 (37%) | 10 (63%) | |||
| 2+ | 3 (3%) | 0 (0%) | |||
| ED treatments | |||||
| Diphenhydramine (%) | 51 (65%) | 8 (53%) | 0.41 | ||
| Other antihistamines (%) | 41 (52%) | 7 (47%) | 0.71 | ||
| Steroids (%) | 72 (91%) | 12 (80%) | 0.20 | ||
| Intravenous fluids (%) | 36 (46%) | 8 (53%) | 0.58 | ||
| Inhaled Beta-agonists (%) | 39 (49%) | 10 (67%) | 0.27 | ||
| Oxygen (%) | 7 (9%) | 1 (7%) | 1.00 | ||
| Inhaled ipratropium (%) | 13 (15%) | 6 (38%) | 0.12 | ||
| Inhaled racemic epinephrine (%) | 8 (10%) | 2 (13%) | 0.86 | ||
| Anti-pyretics (%) | 5 (6%) | 1 (6%) | 1.00 | ||
| Anti-emetics (%) | 4 (5%) | 2 (13%) | 0.44 | ||
| Number ED epinephrine doses (%) | 0.37 | ||||
| 0 | 33 (39%) | 5 (31%) | |||
| 1 | 42 (50%) | 7 (44%) | |||
| 2+ | 9 (11%) | 4 (25%) | |||
| 2+ doses of epinephrine before hospital admission (pre-ED/ED) (%) | 23 (32%) | 7 (44%) | 0.35 | ||
| Symptoms consistent with anaphylaxis† during hospitalization | 6 (7%) | 2 (13%) | 0.61 | ||
IQR denotes interquartile range; ED, emergency department.
*
Defined as inpatient treatment with 1) epinephrine, 2) a significant respiratory intervention (i.e. inhaled albuterol, inhaled racemic epinephrine or respiratory support including oxygen delivery or intubation) or 3) a significant cardiovascular intervention (i.e. use of vaso-pressors or IV fluid resuscitation).
†
Anaphylaxis defined as signs/symptoms documented in the medical record that included involvement of two or more organ systems or hypotension based on the 2011 NIAID/FAAN guidelines.