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Abstract

Introduction: Food allergy affects about 4 percent of the general population and up to 6 to 8 percent of children less than five years of age in the United States. Anaphylaxis is a serious allergic reaction (type 1) that is rapid in onset and may cause death. Food is the leading cause among identified triggers of anaphylaxis in children and is responsible for up to one-half of reported anaphylaxis cases presenting to emergency departments in developed countries around the world. Beyond single center estimates, outcomes associated with food-induced anaphylactic shock in children are unclear and may provide important clues for primary prevention and effective resource utilization. Methods: A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) for the years 2008 to 2010 was used for the current study. The NEDS is a part of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. All children (aged <=21 years) visiting a hospital based emergency department (ED) with a diagnosis of Anaphylactic Shock induced by food (ICD 9 CM code of 995.60 to 995.69) were selected. Characteristics examined included age, gender and types of food causing anaphylactic shock. Outcomes examined included disposition information following ED visit and hospital ED charges. Descriptive analyses were used. Results: During the study period, a total of 20,726 ED visits were due to food induced anaphylaxis. The mean age of these ED visits was 9 years. Males comprised 57.2% of all ED visits. Following ED visit, 82.7% were discharged routinely, 13.2% were admitted as inpatients into the same hospital, and 2.6% were transferred to another short term hospital. About 34% of all ED visits occurred over the weekends. The mean ED charge (inflation adjusted to year 2010) per visit was $1,470 and the total ED charges across the entire United States was $25.7 million. Foods that induced anaphylaxis included: peanuts (32.5% of all ED visits), tree nuts and seeds (16%), fish (6.9%), crustaceans (4.3%), milk products (4.3%), fruits and vegetables (4.1%), eggs (3.3%), food additives (0.5%), other specified food (17.7%), and unspecified food (11.2%). Conclusions: Anaphylaxis is a common cause of ED visit in children in the United States with the majority of patients being treated and discharged from the ED. Hospital resource utilization is significant. The common types of food triggering anaphylactic shock are described.