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Anaphylaxis risk factors for hospitalization and intensive care: A comparison between adults and children in an upstate New York emergency department

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Background:

Anaphylaxis is an acute, systemic allergic reaction that can be life threatening, and with an increasing incidence and costs associated with hospitalization and intensive care.

Objective:

To assess the risk factors for hospitalization by comparing pediatric and adult patients.

Methods:

We performed a retrospective chart review for patients with anaphylactic reactions who presented to the Albany Medical Center emergency department between 2005 and 2012.

Results:

We identified 267 anaphylactic reactions in 258 patients (143 adults). Of those, 128 (48%) were not coded as anaphylaxis despite fulfilling diagnostic criteria. Foods were the most common trigger both in adults and children. Factors associated with increased odds of hospitalization (intensive care unit [ICU] and hospital floor combined) included a severity score of 3 in both children (odds ratio [OR] 41.86 [95% confidence interval {CI}, 2.9‐602.48], p = 0.006) and adults (OR 32.52 [95% CI, 6.28‐168.35], p < 0.001), and those who received multiple doses of epinephrine in children (OR 15.36 [95% CI, 1.9‐121.4], p = 0.009) and adults (OR 11.49 [95% CI, 3.08‐44.13], p < 0.001). Patient characteristics associated with ICU admission in children and adults combined included Medicare and/or Medicaid insurance (OR 4.96 [95% CI, 1.14‐21.67], p = 0.023), cutaneous symptoms (OR 0.19 [95% CI, 0.04‐0.79], p = 0.23), and cardiovascular symptoms (OR 5.8 [95% CI, 1.16‐28.87], p = 0.032).

Conclusion:

Anaphylaxis remains underrecognized and improperly treated in the emergency department. Severity of symptoms and receiving multiple doses of epinephrine were associated with hospitalization in both children and adults. Medicare and/or Medicaid insurance, and cardiovascular or cutaneous symptoms were characteristics associated with ICU admission in our cohort.
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Keywords: Anaphylaxis; allergic reaction; drug allergy; emergency; epinephrine; food allergy; hospitalization; insect allergy; insurance; urticaria

Document Type: Research Article

Affiliations: 1: From the Division of Allergy and Immunology, Department of Medicine, Albany Medical College School of Medicine, Albany, New York 2: Department of Emergency Medicine, Albany Medical College School of Medicine, Albany, New York 3: Department of Biostatistics and Computational Biology, University of Rochester School of Medicine, Rochester, New York

Publication date: January 1, 2019

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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