Impact of Reaction Setting on the Management, Severity, and Outcome of Pediatric Food-Induced Anaphylaxis: A Cross-Sectional Study.

Autor:	Prosty C; Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, Quebec, Canada. Electronic address: connor.prosty@mail.mcgill.ca., Colli MD; Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, Quebec, Canada., Gabrielli S; Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, Quebec, Canada., Clarke AE; Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada., Morris J; Department of Emergency Medicine, Hôpital Sacré-Coeur, Montréal, Quebec, Canada., Gravel J; Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada., Lim R; Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ont, Canada., Chan ES; Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada., Goldman RD; Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, and the BC Children's Research Institute, University of British Columbia, Vancouver, BC, Canada., O'Keefe A; Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, NL, Canada., Gerdts J; Food Allergy Canada, Toronto, Ont, Canada., Chu DK; Division of Clinical Immunology and Allergy, Department of Medicine, and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont, Canada., Upton J; Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ont, Canada., Hochstadter E; Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ont, Canada., Bretholz A; Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montréal, Quebec, Canada., McCusker C; Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, Quebec, Canada., Zhang X; Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada., Protudjer JLP; Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Man, Canada; Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Man, Canada; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden., Ben-Shoshan M; Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, Quebec, Canada.
Jazyk:	angličtina
Zdroj:	The journal of allergy and clinical immunology. In practice [J Allergy Clin Immunol Pract] 2022 Dec; Vol. 10 (12), pp. 3163-3171. Date of Electronic Publication: 2022 Sep 23.
DOI:	10.1016/j.jaip.2022.09.015
Abstrakt:	Background: Prompt epinephrine autoinjector (EAI) use is the primary treatment for anaphylaxis. However, limited Canadian data exist on the impact of reaction location on EAI use for food-induced anaphylaxis (FIA). Objective: We sought to investigate the setting, management, and severity of pediatric FIA. Methods: We recruited children presenting with FIA from 11 Canadian emergency departments. Patient demographics and the setting, management, and symptoms of FIA were collected by standardized questionnaire. Factors associated with prehospital EAI use and reaction severity were determined by logistic regression. Results: We recruited 3,604 children; 60.2% were male and the median age was 5.0 years (interquartile range 1.8-11.0). Among cases with a known location of FIA (85.0%), home was the most common setting (68.1%), followed by school/daycare (12.8%), other locations (11.4%; eg, park, car), and restaurants (7.4%). In the prehospital setting, EAI was administered in 36.7% of reactions at home, 66.7% in school/daycare, 40.2% in other locations, and 44.5% in restaurants. Relative to reactions occurring at school/daycare, prehospital EAI use was less likely at home (adjusted odds ratio [aOR] 0.80; 95% CI 0.76-0.84), in restaurants (aOR 0.81; 95% CI 0.75-0.87), and in other settings (aOR 0.77; 95% CI 0.73-0.83), when data were adjusted for reaction severity, sex, age, comorbidities, and province. The FIA setting was not associated with reaction severity or hospitalization. Conclusions: Prehospital EAI use was higher at school/daycare than in other settings, potentially owing to the presence of policies and training on FIA. Setting-specific interventions including educational programs and policies/laws mandating training and stocking an EAI may improve anaphylaxis recognition and treatment. (Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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