Risk Factors for Severe Anaphylaxis in Children

Abstract

To understand factors that would help identify patients who are at an increased risk of developing severe anaphylaxis.In this study, the researchers included 453 emergency department (ED) visits identified with anaphylaxis in a 2-year time period (May 2016 to April 2018) in 7 pediatric EDs in Spain.This was a prospective multicenter study in 7 pediatric EDs in which researchers had ED staff recruit patients to participate at the time of anaphylaxis diagnosis. The ED provider completed a data questionnaire at the time of discharge from the hospital or admission to the hospital. The questionnaire and the treatment of each patient were then reviewed, with a significant focus on the 61 visits of patients diagnosed with severe anaphylaxis that met ≥1 of the following criteria: ≥2 doses of epinephrine, clinically important biphasic reaction, endotracheal intubation, intensive care admission, and/or death.With the use of multivariable regression, 5 independent risk factors were found for severe anaphylaxis including (1) a history of asthma, (2) an onset of symptoms <5 minutes after allergen exposure, (3) a nonwell appearance, (4) tachycardia, and (5) hypotension. Furthermore, the risk of severe anaphylaxis increased with each additional risk factor.In this study, the researchers identified 5 factors that increased the risk of severe anaphylaxis. These should be considered in the management of anaphylaxis cases in the ED, such as planning for inpatient observation versus outpatient management.The significant limitations of this study include that∼20% of anaphylaxis ED cases were not recruited for the study, and the baseline asthma control was not assessed, thus they were unable to identify if the link between asthma and severe anaphylaxis is more an association with uncontrolled asthma at baseline rather than simply an asthma diagnosis. Regardless of these limitations, the prospective nature of this study out of the ED allowed them to include nearly all patients who come to the ED for anaphylaxis evaluation. This is significant when compared with prospective reviews completed from allergy clinic follow-up as a number patients with anaphylaxis who are treated in the ED do not have proper follow-up. Finally, this study identified factors that may increase the risk of complications from anaphylaxis that would be helpful to consider when deciding between inpatient monitoring versus outpatient management.