Food remains the most common anaphylactic trigger
Food continues to be the most common trigger for anaphylaxis, a rapid-onset and potentially fatal hypersensitivity reaction, according to evidence presented at the AAAAI/WAO* Joint Congress 2018 held in Orlando, Florida, US.
In a study evaluating 1,989 children admitted for anaphylaxis in North American paediatric intensive care units (PICU), food has been established as the most common anaphylactic trigger, with peanuts causing majority of the cases (approximately 45 percent) followed by tree nuts/seeds (19 percent) and milk (10 percent). [AAAAI/WAO 2018, abstract 470]
The burden of paediatric anaphylaxis was about 0.3 percent of all PICU admissions, which was “higher than anticipated”, said Dr Carla Davis from the Baylor College of Medicine in Houston, Texas, US. “This means food-induced anaphylaxis should be considered a serious medical condition and aggressively prevented and treated. Physicians should identify at-risk patients and frequently review avoidance measures.”
This study is important because it gives insight into the burden of anaphylaxis in paediatric patients on an international level,” added Davis. “The characteristics of anaphylaxis in children including epidemiology, morbidity, and mortality tend to be underreported, even though the information could give insights into patterns and possible interventions.”
Another record review showed food allergies as the main trigger for paediatric anaphylactic episodes (55 percent), which were primarily attributed to tree nuts and peanuts (25 percent and 18 percent, respectively). This study also showed the underutilization of epinephrine compared with steroids and antihistamines for anaphylaxis management (32 percent vs 78 percent and 52 percent). [AAAAI/WAO 2018, abstract 506]
Epinephrine: First-line defence
Epinephrine underutilization was further highlighted in a separate retrospective analysis, which showed that out of 116 evaluable patients, only 34 percent had an epinephrine autoinjector available at the time of their reaction. [AAAAI/WAO 2018, abstract 493]
These findings underscore that patients still use other options such as antihistamines despite recommendations for epinephrine as first-line treatment for anaphylaxis, noted the researchers. Therefore, it is important to consistently educate patients on alternatives for anaphylaxis management to receive the best possible treatment, they added.
The value of correct diagnosis
However, one of the treatment drawbacks identified in another retrospective review was the improper coding of anaphylaxis which could influence treatment options. Of the 1,341 potential anaphylaxis cases, 60 met the criteria but only 23 percent were correctly diagnosed, while the rest were inappropriately coded as an ‘‘allergic reaction’’. [AAAAI/WAO 2018, abstract 485]
Additionally, only 20 percent received epinephrine, and there were only four out of eight patients who appeared for allergy evaluation.
“The observed high rate of miscoding [anaphylaxis] and low rates of epinephrine administration, of prescribing epinephrine autoinjectors, and of referral for allergy evaluation, call for more education on these issues in the [emergency department (ED)],” said the researchers of this trial.
Taken together, these findings highlight the importance of more collaborative efforts between allergists and ED physicians to develop tools that can standardize patient documentation and identification in order to streamline management protocols to improve long-term outcomes.