P091: Anaphylaxis: epidemiology and treatment in a Canadian emergency department

Abstract

Introduction: As part of the multicenter C-CARE (Cross-Canada Anaphylaxis Registry) project, this study aimed to describe the characteristics of anaphylactic reactions and assess if emergency physicians follow treatment guidelines. Methods: A cohort study was conducted in the emergency department of Sacré-Cœur Hospital, a university-affiliated, urban tertiary care hospital. For each anaphylaxis case recruited by the treating physician, a standardised questionnaire was completed. The information for missed cases was collected retrospectively through chart review. Results: Between May 2012 and May 2015, 280 cases (205 prospective and 75 retrospective) of anaphylaxis were identified from a total of 182,408 ED visits. The median age was 36.21 years (IQR 27.8), 61.8% were female, and 12.5% of all patients were children (<18 years old). The majority of reactions were triggered by food [54.3% (95%CI:48.5-60.1%)], followed by medications [18.2% (95%CI:13.7-22.7%)] and venom [5.7% (95%CI:3.0-8.4%)]. Among all cases, 66.8% (95%CI:61.3-72.3%) received epinephrine; 26.1% (95%CI:21.0-31.2%) received it prior to their arrival and 46.8% (95%CI:41.0-52.6%) in-hospital. As for other in-hospital treatments, 85.4% of patients (95%CI:81.3-89.5%) received corticosteroids, 81.1% (95%CI:76.5-85.7%) received H1 antihistamines, and 41.1% (95%CI:35.3-46.9%) received H2 antihistamines. Out of all patients who had anaphylaxis, 86.4% (95%CI:82.4-90.4%) were prescribed an epinephrine auto-injector in-hospital or had already had one prescribed. Conclusion: Our results reveal that food is a major trigger of anaphylaxis and that despite current guidelines, there is under use of epinephrine and preferential use of corticosteroids and antihistamines.