Multicenter study of emergency department visits for food allergies

被引:211
作者
Clark, S
Bock, SA
Gaeta, TJ
Brenner, BE
Cydulka, RK
Camargo, CA
机构
[1] Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA 02114 USA
[2] Natl Jewish Med & Res Ctr, Denver, CO USA
[3] New York Methodist Hosp, Dept Emergency Med, Brooklyn, NY USA
[4] Univ Arkansas Med Sci, Dept Emergency Med, Little Rock, AR 72204 USA
[5] Metrohlth Med Ctr, Dept Emergency Med, Cleveland, OH USA
[6] Harvard Univ, Sch Med, Brigham & Womens Hosp, Channing Lab,Dept Med, Boston, MA USA
关键词
food allergy; emergency department; epinephrine;
D O I
10.1016/j.jaci.2003.10.053
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: Relatively little is known about the characteristics of patients who visit the emergency department (ED) for an acute allergic reaction. Although anaphylaxis guidelines suggest treatment with epinephrine, teaching about self-injectable epinephrine, and referral to an allergist, current ED management remains uncertain. Objective: The objective of this study was to describe the management of food-related acute allergic reactions. Methods: The Multicenter Airway Research Collaboration performed a chart review study in 21 North American EDs. Investigators reviewed a random sample of 678 charts of patients who presented with food allergy (International Classification of Diseases-ninth revision codes 693.1, 995.0, 995.3, and 995.60-995.69). Results: Patients had an average age of 29 years; the cohort was 57% female and 40% white. A variety of foods provoked the allergic reaction, including nuts (21%), crustaceans (19%), fruit (12%), and fish (10%). Although exposure to these foods can be life threatening, only 18% of patients came to the ED by ambulance. In the ED, 72% of patients received antihistamines, 48% received systemic corticosteroids, and 16% received epinephrine; 33% received respiratory treatments such as inhaled albuterol. Among patients with severe reactions (55% of total), 24% received epinephrine. Overall, 97% of patients were discharged to home. At ED discharge, 16% of patients were prescribed self-injectable epinephrine, and 12% were referred to an allergist. Conclusions: Although guidelines suggest specific approaches for the management of acute allergic reactions, ED concordance for food allergy appears low. These findings support a new collaboration between professional organizations in allergy and emergency medicine and the development of educational programs and materials for ED patients and staff.
引用
收藏
页码:347 / 352
页数:6
相关论文
共 18 条
[1]   Fatalities due to anaphylactic reactions to foods [J].
Bock, SA ;
Muñoz-Furlong, A ;
Sampson, HA .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2001, 107 (01) :191-193
[2]   Emergency department anaphylaxis: A review of 142 patients in a single year [J].
Brown, AFT ;
McKinnon, D .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2001, 108 (05) :861-866
[3]   Anaphylaxis and food allergy [J].
Burks, AW ;
Sampson, HA .
CLINICAL REVIEWS IN ALLERGY & IMMUNOLOGY, 1999, 17 (03) :339-360
[4]  
GAETA TJ, 2001, ACAD EMERG MED, V8, P449
[5]  
Hosmer D. W., 1989, APPL LOGISTIC REGRES, DOI DOI 10.1097/00019514-200604000-00003
[6]   UNDERREPORTING OF ANAPHYLAXIS IN A COMMUNITY EMERGENCY ROOM [J].
KLEIN, JS ;
YOCUM, MW .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 1995, 95 (02) :637-638
[7]  
KRAUSE R, 1999, ANAPHYLAXIS
[8]   Epidemiology of anaphylaxis in the United States [J].
Matasar, MJ ;
Neugut, AI .
CURRENT ALLERGY AND ASTHMA REPORTS, 2003, 3 (01) :30-35
[9]   FATAL AND NEAR-FATAL ANAPHYLACTIC REACTIONS TO FOOD IN CHILDREN AND ADOLESCENTS [J].
SAMPSON, HA ;
MENDELSON, L ;
ROSEN, JP .
NEW ENGLAND JOURNAL OF MEDICINE, 1992, 327 (06) :380-384
[10]   ACUTE ALLERGIC DISEASE IN A HOSPITAL EMERGENCY ROOM - A RETROSPECTIVE EVALUATION OF ONE YEARS EXPERIENCE [J].
SCHWARTZ, HJ .
ALLERGY PROCEEDINGS, 1995, 16 (05) :247-250