Children who skip the ED after anaphylaxis during OIT use epinephrine at home
Click Here to Manage Email Alerts
Key takeaways:
- Most anaphylactic reactions were moderate and occurred during the up-dosing phase of OIT treatment.
- About half of all patients used antihistamines to treat anaphylactic symptoms while they were still at home.
SAN ANTONIO — Children on OIT who used epinephrine to treat anaphylaxis went to the ED less often than those who did not use epinephrine, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
“Prompt use of epinephrine is recommended to treat anaphylaxis,” Sofianne Gabrielli, MSc, MDCM candidate with the division of experimental medicine, Faculty of Medicine, McGill University, said during her presentation.
However, Gabrielli continued, data on the obligatory need to present to the ED after epinephrine use in treating anaphylaxis are scant.
“We aimed to compare the clinical characteristics and anaphylaxis management between children who are not seen in the ED and children transferred to the ED,” she said.
The researchers recruited children with a diagnosed milk allergy who were being treated with OIT at Montreal Children’s Hospital, the British Columbia Children’s Hospital and The Hospital for Sick Children.
Next, the researchers queried participants about allergic and/or anaphylactic reactions related to their milk OIT ingestion that they experienced at home to determine prehospital management and transport to the ED.
The researchers then used the non-parametric Wilcoxon rank sum test to compare the rates of pre-hospital epinephrine use between the patients who did and did not go to the ED.
“Only reactions meeting the definition of anaphylaxis according to the National Institute of Allergy and Infectious Disease classification were included,” Gabrielli said.
Also, the researchers used the grading system developed by Muraro et al to classify the severity of each anaphylaxis case.
“Between 2015 and 2022, 52 anaphylactic reactions at home were reported,” Gabrielli said.
There also were seven non-anaphylactic reactions for a total of 59 reactions, including 46 reported by Montreal Children’s Hospital, three reported by the Hospital for Sick Children and three reported by British Columbia Children’s Hospital. Additionally, 22 of these children visited an ED, and 37 did not.
“In both groups, the majority of the reactions occurred during the up-dosing phase,” Gabrielli said.
Specifically, three (13.6%) of the patients who visited the ED were in the maintenance phase, and 19 (86.4%) were in the up-dosing phase. Similarly, those who did not visit the ED included 12 (32.4%) in maintenance and 25 (67.6%) in up-dosing.
There also were three allergic reactions among those who visited the ED, including one that was moderate and two that were severe, and four moderate allergic reactions among those who did not visit the ED.
Further, there were 19 anaphylactic reactions including 13 moderate reactions (68.4%) among those patients who visited the ED and 33 anaphylactic reactions (89.2%) including 24 (72.7%) moderate reactions among those who did not visit the ED.
Symptoms in these moderately severe cases included cramping abdominal pain, recurrent vomiting, diarrhea, a barky cough, a hoarse voice, difficulty swallowing, dyspnea, moderate wheezing and lightheadedness.
When asked about treating the anaphylaxis at home, all 12 of those who responded from the ED group said they did so, including nine with epinephrine, six with antihistamines and four with salbuterol. All 37 of the patients who did not visit the ED used epinephrine at home, along 19 who used antihistamines, three who used steroids and 10 who used salbuterol.
Treatment in the ED, among 12 reporting participants, included epinephrine for four, antihistamines for one, and steroids and salbuterol for two apiece, whereas seven received no treatment.
Most patients reported that the anaphylaxis involved multiple organ systems. For example, among patients who visited the ED, 12 said two systems were affected, and four said three systems were affected. Among those who did not visit the ED, 18 said two systems were affected, and 13 said three systems were affected.
Based on the Wilcoxon rank sum test, Gabrielli said, prehospital epinephrine use was significantly higher among the patients who did not present to the ED (P = .001).
“Given the low use of epinephrine, it is possible that there is a higher hesitancy to use an epinephrine autoinjector among families of children going to the ED for an anaphylactic reaction,” Gabrielli said.