Volume 6 Supplement 1

Canadian Society of Allergy and Clinical Immunology Annual Scientific Meeting 2009

Open Access

Treatment of initial allergic reactions to peanut inside and outside of health care facilities

  • L Soller1,
  • M Ben-Shoshan2,
  • J Fragapane1,
  • L Joseph1, 3,
  • Y St Pierre1,
  • L Harada4,
  • C Fortin5,
  • M Allen6 and
  • AE Clarke1, 7
Allergy, Asthma & Clinical Immunology20106(Suppl 1):P31

https://doi.org/10.1186/1710-1492-6-S1-P31

Published: 12 May 2010

Background

Recent studies suggest increased admission rates for food-related anaphylaxis. The only effective treatment for anaphylaxis is prompt administration of epinephrine.

Objectives

To characterize treatment practices of initial allergic reactions inside and outside health care facilities (HCF).

Methods

Individuals with an allergist-confirmed peanut allergy were recruited from the Montreal’s Children Hospital and Canadian food allergy advocacy organizations. Data were collected on initial allergic reactions to peanut and treatment inside and outside HCFs.

Results

Of 751 individuals who had an allergic reaction to peanut, 613 responded (81.6%). Initial reactions were mild in 28.4% (95% CI, 25.0-32.1%), moderate in 50.6% (46.6-54.6%), and severe in 20.9% (17.8-24.3%). Average age of initial reaction was 2.1 years (2.0-2.3). Among participants, 11.6% (9.1-14.7%) were diagnosed with peanut allergy (based on skin and IgE testing) prior to the initial reaction. Of the 613 participants, 32.1% (28.5-36.0%) were treated in HCFs only, 51.7% (47.7-55.7) outside HCFs only, and 16.2% (13.4-19.3%) in both. 21.3% (17.0-26.3%) of all reactions treated in HCFs received epinephrine (table) versus only 3% (1.8-5.1%) treated outside. Of those with moderate or severe initial reactions, 58.2% (53.5-62.8%) were treated in HCFs, and 23.9% (19.1-29.6%) of these received epinephrine. See table 1.
Table 1

Table 1

 

% of Respondents Receiving each Treatment in HCF

% of Respondents Receiving each Treatment outside HCF

 

Epinephrine +/- other medications% (95% CI)

Other medications (excluding epinephrine)

None

Epinephrine +/- other medications

Other medications (excluding epinephrine)

None

All reactions

21.3 (17.0-26.3)

50.7 (45.0-56.4)

28.0 (23.2-33.5)

3.0 (1.8-5.1)

47.2 (42.6-51.8)

49.8 (45.2-54.4)

Severity

      

Mild

4.9 (1.5-16.2)

39.0 (25.6-54.4)

56.1 (40.1-70.2)

0.0 (0.0-2.6)

50.4 (41.1-58.5)

49.6 (41.5-57.8)

Moderate

15.1 (10.4-21.5)

54.1 (46.3-61.7)

30.8 (24.1-38-4)

4.3 (2.3-7.8)

46.8 (40.4-53.2)

48.9 (42.5-55.4)

Severe

38.5 (29.4-48.6)

50.0 (40.1-59.9)

11.5 (6.5-19.4)

4.5 (1.8-11.2)

43.2 (33.3-53.7)

52.3 (41.9-62.5)

Peanut allergy diagnosed prior to reaction

      

Yes

17.2 (7.7-34.8)

48.3 (31.3-65.7)

34.5 (20.0-52.9)

6.5 (2.3-17.6)

67.4 (52.8-79.2)

26.1 (15.6-40.4)

No

20.9 (16.0-26.8)

53.6 (47.0-60.2)

25.5 (20.1-31.6)

2.7 (1.4-5.0)

44.7 (39.4-50.0)

52.6 (47.3-58.0)

Conclusion

Almost 50% of individuals with potentially life-threatening initial reactions are not treated in HCFs. Further, for those with moderate and severe reactions treated in HCFs, there is substantial underuse of epinephrine. Thus, it is crucial to establish, distribute, and monitor treatment guidelines that would improve treatment practices of food-related allergic reactions.

Authors’ Affiliations

(1)
Division of Clinical Epidemiology, Department of Medicine, McGill University Health Center
(2)
Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center
(3)
Departments of Epidemiology and Biostatistics, McGill University
(4)
Anaphylaxis Canada (AC)
(5)
Association Québécoise des Allergies Alimentaires (AQAA)
(6)
Allergy/Asthma Information Association (AAIA)
(7)
Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center

Copyright

© Soller et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

Advertisement