Anaphylaxis treated in a Canadian pediatric hospital: Incidence, clinical characteristics, triggers, and management

Epinephrine should not be delayed by the use of antihistamines and corticosteroids, which do not relieve upper airway obstruction.3,8 However, in our study 23.6% of patients were treated only with steroids or antihistamines; a recent European study reported similar findings.11 Our results are consistent with those of other studies reporting greater severity in those with known asthma and in cases induced by peanut and venom.3 It is suggested that there are greater levels of the anaphylatoxin receptors C3aR and C5aR in the lungs of patients with severe or uncontrolled asthma that render them more sensitive to the effects of systemic anaphylaxis.12 Given that our data are collected from 1 hospital, they might not be representative of the entire population. Peanut[double dagger] 30.0 (20.0-42.3) 29.2 (19.3-41.2) 29.5 (22.4-37.9) Tree nut[double dagger] 17.1 (9.5-28.4) 14.0 (7.2-24.5) 15.5 (10.2-22.7) Peanut or tree nut[double dagger] 47.1 (35.2-59.4) 43.1 (31.6-55.2) 45.0 (36.8-53.6) Nuts§ 1.4 (0.07-8.8) 12.5 (6.2-22.9) 7.0 (3.6-12.9) Milk[double dagger] 7.1 (2.7-16.6) 6.9 (2.6-16.1) 7.0 (3.6-12.9) Egg[double dagger] 2.9 (0.5-10.9) 8.3 (3.4-17.9) 5.6 (2.6-11.2) Fish[double dagger] 8.6 (3.5-18.4) 2.8 (0.5-10.8) 5.6 (2.6-11.2) Shellfish[double dagger] 5.7 (1.8-14.7) 4.2 (1.1-12.5) 4.1 (1.8-8.7) Sesame[double dagger] 2.9 (0.5-10.9) 2.8 (0.5-10.8) 2.8 (0.9-7.5) Kiwi[double dagger] 1.4 (0.07-8.8) 1.3 (0.07-8.5) 1.4 (0.2-5.5) Soy[double dagger] 1.4 (0.07-8.8) 0.0 (0.0-6.3) 0.7 (0.04-4.4) Wheat[double dagger] 1.4 (0.07-8.8) 0.0 (0.0-6.3) 0.7 (0.04-4.4) Reaction at home 66.2 (54.5-76.4) 46.1 (34.7-57.8) 56.2 (48.0-64.1) Reaction at school/day care 13.0 (7.7-23.0) 6.6 (2.4-15.3) 9.8 (5.8-15.9) Reaction during exercise 8.5 (3.5-18.1) 5.2 (1.3-15.2) 7.0 (3.4-13.2)|| Reaction during exercise in the context of food exposure 4.4 (1.1-13.2) 3.4 (0.6-12.9) 3.9 (1.4-9.3)|| Table E1 Reaction characteristics Predictor Univariate (OR [95% CI]) Multivariate[low *] (OR [95% CI]) Peanut exposure 11.2 (2.9-43.6) 18.8 (3.3-107.4) Venom exposure 7.6 (1.2-46.6) 95.5 (7.7-1182.3) Asthma 3.4 (1.0-11.6) 8.3 (1.7-40.4) Table E2 Predictors of reaction severity OR, Odds ratio.