Increase in Epinephrine Administration for Food-Induced Anaphylaxis in Pediatric Emergency Departments From 2007 to 2015

Abstract

Background: Epinephrine is underused in the treatment of anaphylaxis, despite being the first-line treatment, which reflects the challenges in diagnosing anaphylaxis and understanding the appropriate therapy.

Objective: To describe trends in epinephrine administration for patients visiting the pediatric emergency department (ED) with food-induced anaphylaxis (FIA) from 2007 to 2015.

Methods: This retrospective cohort study included children 0 to 17 years of age with FIA from 46 children's hospitals in the United States between 2007 and 2015. Multivariable regression was used to identify factors associated with epinephrine administration.

Results: A total of 15,318 cases of FIA cases were seen in the pediatric EDs from 2007 to 2015. Among these ED visits, 7,600 (49.6%) had at least 1 dose of epinephrine administered in the ED. Administration of epinephrine for anaphylaxis in the pediatric ED increased by 4% each year (odds ratio [OR] 1.04; 95% CI 1.03-1.05; P < .001). Sensitivity analysis by census region demonstrated that hospitals in the Northeast and the West were associated with an increase in epinephrine administration per year (Northeast OR 1.18, 95% CI 1.13-1.22, P < .001; West OR 1.14, 95% CI 1.10-1.18, P < .001).

Conclusions: Epinephrine administration for FIA in the pediatric ED has increased over time, reflecting the need for continued advocacy for the optimal management of FIA. Further research is warranted to identify optimal strategies for proper recognition and early administration of epinephrine for anaphylaxis.

Keywords: Emergency department; Epinephrine; Food allergy; Food-induced anaphylaxis.