November 13, 2019
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Young children visiting ED more, hospitalized less for anaphylaxis

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HOUSTON — Between 2006 to 2015, the number of children aged younger than 3 years who visited the ED for anaphylaxis increased, but the number of subsequent hospitalizations decreased, according to findings presented at the American College of Asthma, Allergy & Immunology Scientific Meeting.

Lacey B. Robinson, MD, a resident in the division of allergy and immunology in the department of medicine at Massachusetts General Hospital, explained during a presentation that the study of anaphylaxis in children aged younger than 3 years is essential because “there are high rates of food-induced anaphylaxis in this age group and importantly, many of these kids actually don’t have a preceding diagnosis of food allergy at their first exposure and first reaction, which means at the time they have anaphylaxis, they don’t have a prescription or access to an epinephrine auto-injector.”

Researchers conducted a retrospective cohort study using a representative database to identify young children with anaphylaxis with an ED visit between 2006 and 2015. When available, ICD-9 codes were used to identify anaphylaxis triggers.

During the study period, ED visits for anaphylaxis more than doubled, from 1,806 in 2006 to 3,770 in 2015 (P < .001).

Emergency Room Sign 
Between 2006 to 2015, the number of children aged younger than 3 years who visited the ED for anaphylaxis increased, but the number of subsequent hospitalizations decreased, according to findings presented at the American College of Asthma, Allergy & Immunology Scientific Meeting.
Source: Adobe Stock

To ensure that this increase was not due to population increases, researchers calculated the proportion of ED visits during the study period. They found that the number of ED visits increased from 15 per 100,000 young children in 2006 to 32 per 100,000 young children (P < .001) in 2015.

Researchers found that among cases with information on anaphylaxis available, 75% were food related.

“Interestingly, when we looked at the hospitalizations, we actually found what we were not expecting,” Robinson said. “We found the rate of hospitalizations for anaphylaxis-related ED visits was declining over time.”

Robinson and colleagues found that the rate of hospitalization after an anaphylaxis-related ED visit dropped from 19% in 2006 to 6% in 2015 (P < .001).

She explained that the decrease in hospitalizations may be due to changes in health care utilization patterns or increased epinephrine use, which has been tied to decreased hospitalizations.

Robinson told attendees that further studies are needed on anaphylaxis in vulnerable populations, health care utilization patterns for allergic diseases and anaphylaxis, and to determine why anaphylaxis is occurring more often. – by Erin Michael

Reference:

Robinson L, et al. A004. Presented at: American College of Asthma, Allergy & Immunology Scientific Meeting; Nov. 7-11, 2019; Houston.

Disclosure: Robinson reports funding from an NIH grant.