PICU admission for anaphylaxis often involves drug reactions, breathing difficulties
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Key takeaways:
- Patients with active asthma symptoms were 14.43 times more likely to be admitted to the PICU.
- Patients admitted to the PICU were 3.71 times more likely to stay for more than 24 hours.
WASHINGTON — When children have anaphylaxis with breathing difficulties, drug reactions and epinephrine doses, pediatric ICU admission is likely, according to a poster presentation here.
Epinephrine use at the hospital also was suboptimal, Omar Yamak, MD, allergy and immunology fellow, division of allergy and immunology, department of pediatrics, Children’s Hospital of Michigan, and colleagues wrote in their poster presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
“Anaphylaxis is a clinical condition with rapid onset and potentially fatal reaction that requires proper recognition and treatment,” Yamak said during his presentation.
Despite efforts to standardize the definition of anaphylaxis, he continued, diagnosis and management remain issues, particularly among children.
“Data and risk factors for pediatric anaphylaxis is lacking,” Yamak said. “We aim to identify risk factors contributing to admission to the [pediatric ICU (PICU)].”
Patient characteristics
The retrospective review comprised the electronic medical records of 138 patients aged 21 years and younger who were diagnosed with anaphylaxis and admitted to the hospital between January 2011 and December 2021.
“Our data consisted of demographics such as age, sex, race, ethnicity, health insurance and zip codes of residence,” Yamak said. “We looked at home medications such as epinephrine and albuterol, and we also looked at the anaphylaxis event.”
These patients included 48 who were admitted to the PICU and 90 who were not. More than 97% of patients in both groups had health insurance, including 70.2% of those in the PICU group and 65.9% of those in the non-PICU group who had private insurance.
Also, 64.6% of the PICU group and 51.1% of the non-PICU group were Black. The largest age groups included age 5 to 13 years in the PICU group (35.4%) and age 14 years and older in the non-PICU group (36.7%).
Both groups had similar rates of asthma, atopic dermatitis and allergic rhinitis, with 28.9% of the non-PICU group and 20.8% of the PICU group reporting concurrent asthma symptoms during presentation.
Intramuscular epinephrine was the first drug administered to 61.1% of the non-PICU group and 70.8% of the PICU group. Food was the most common trigger, particularly peanuts and tree nuts, for both the PICU group (59.5%) and the non-PICU group (57.1%).
Physicians ordered tryptase for 22.9% of the PICU group and 7.8% of the non-PICU group. Also, physicians requested allergy consultations for 43.3% of the non-PICU group and 64.6% of the PICU group.
Allergy follow-up appointments were scheduled for 57.8% of the non-PICU group and 62.5% of the PICU group, with 51.9% of the non-PICU group and 33.3% of the PICU patients attending these appointments.
Leading factors in admission
Patients with respiratory symptoms were 5.05 (95% CI, 1.41-18.09) times more likely to be admitted to the PICU than those with no respiratory symptoms.
Also, patients who experienced drug-induced anaphylaxis were 17.46 (95% CI, 2.03-150.19) times more likely to be admitted to the PICU than those with food-induced anaphylaxis.
Multiple does of epinephrine were associated with 3.389 (95% CI, 1.3-8.64) times greater risk for admission to the PICU compared with patients who did not receive multiple doses.
Compared with patients who did not have active asthma symptoms, those who did have active symptoms were 14.43 (95% CI, 2.94-70.87) times more likely to be admitted to the PICU.
Patients admitted to the PICU were 3.71 (95% CI, 1.4-9.86) times more likely to stay in the hospital for more than 24 hours than those who were not admitted to the PICU.
Additionally, 15% of the patients who were admitted to the PICU had altered mentation, and 25% required mechanical ventilation.
Risk factors for admission to the hospital without PICU care included active asthma (OR = 14.43), nonactive asthma (OR = 1.63), food allergy (OR = 3.76), drug allergy (OR =24.1) and atopic dermatitis (OR = 3.34).
“What these data tell us is that children presenting with difficulty breathing, drug reactions and multiple epinephrine doses are likely to be admitted to the PICU,” Yamak said.
Yamak also called epinephrine use suboptimal in hospital settings and emphasized the need for physicians at the hospital to seek consultations for allergy care.
“And lastly, admission to the intensive care unit increases health expenditures,” he said.