Reassessing Risk of Severe Anaphylaxis and History of Asthma

Abstract

Research Article| September 01 2020 Reassessing Risk of Severe Anaphylaxis and History of Asthma AAP Grand Rounds (2020) 44 (3): 28. https://doi.org/10.1542/gr.44-3-28 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Reassessing Risk of Severe Anaphylaxis and History of Asthma. AAP Grand Rounds September 2020; 44 (3): 28. https://doi.org/10.1542/gr.44-3-28 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: anaphylaxis, asthma Source: Dribin TE, Michelson KA, Zhang Y, et al. Are children with a history of asthma more likely to have severe anaphylactic reactions? A retrospective cohort study. J Pediatr. 2020; 220: 159– 164.e2; doi: https://doi.org/10.1016/j.jpeds.2019.12.019Google Scholar Investigators from Cincinnati Children’s Hospital Medical Center, OH, and Boston Children’s Hospital, MA, conducted a retrospective cohort study to assess whether a history of asthma was associated with anaphylaxis severity. Children were eligible if they were 6 months to 18 years old, presented to the study ED with anaphylaxis between 2009–2016, and were hospitalized. Eligible children were identified through chart review using a combination of ICD-9 and ICD-10 codes for allergic reactions, anaphylaxis, or adverse drug reactions followed by manual review to confirm that diagnostic criteria for anaphylaxis were met as defined by the National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network. Children transferred from outside facilities or who were on oral corticosteroids were excluded. Demographics and clinical characteristics were obtained from the medical chart. The primary predictor was a history of asthma, as obtained from review of provider documentation in the medical chart. The primary outcome was severe anaphylactic reaction, obtained from the medical chart and defined as the presence of at least one examination finding (stridor, hypotension, or respiratory distress) during the first 4 hours of ED care or receipt of at least one acute therapy (≥2 doses of IM epinephrine, use of continuous albuterol, initiation of positive pressure ventilation, or use of vasopressors) in the prehospital, ED, or inpatient setting. The investigators used multivariable logistic regression to determine the association of the predictor and outcome after adjusting for demographics and other clinical characteristics. There were 603 children included in analysis, 231 (38.3%) of whom had a history of asthma. Overall, 38 (6%) participants had stridor during the first 4 hours of ED care, 246 (41%) had respiratory distress, and 26 (4%) had hypotension. In addition, 139 (23%) received ≥2 doses of IM epinephrine in the prehospital and ED setting, while 3 (0.5%) received ≥2 doses of IM epinephrine in the inpatient setting. There were 12 (2%) participants who received vasopressors in the prehospital and ED setting and 11 (1.8%) participants who received vasopressors in the inpatient setting. In multivariable analyses, there was no association between a history of asthma and a severe anaphylactic reaction (adjusted odds ratio 0.97; 95% CI, 0.67, 1.39). The authors conclude that children with a history of asthma who are hospitalized with anaphylaxis do not have more severe anaphylactic reactions than those without a history of asthma. Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The American Academy of Allergy, Asthma, and Immunology and the European Academy of Allergy and Clinical Immunology both recommend a prolonged period of observation for children with asthma who experience a severe anaphylactic reaction.1,2 This... You do not currently have access to this content.