Epinephrine autoinjector prescription filling after pediatric emergency department discharge.

Background: There are known racial and socioeconomic disparities in the use of epinephrine autoinjectors (EAI) for anaphylaxis. Objective: To measure the rates of EAI prescription filling and identify patient demographic factors associated with filling rates among patients discharged from the pediatric emergency department. Methods: This was a retrospective observational cohort study of all patients discharged from a pediatric emergency department who received an outpatient prescription for an EAI between January 1, 2018, and October 31, 2019. The rates of prescription filling were calculated, and multivariable logistic regression was performed to identify sociodemographic factors associated with prescription filling. Results: Of 717 patients included in the analysis, 54.8% (95% confidence interval {CI}, 51.1%-58.5%) filled their prescription. There were no significant associations between EAI fill rates and patient age or sex. In bivariable analysis, non-Hispanic white patients were more likely to fill EAI prescriptions compared with non-Hispanic Black patients (odds ratio [OR] 1.89 [95% CI, 1.11-3.20]), and patients with in-state Medicaid were significantly less likely to fill EAI prescriptions compared with those patients with private insurance (OR 0.69 [95% CI, 0.48-0.98]). However, after multivariable adjustment, there was no significant difference in filling by age, insurance status, or race or ethnicity. Conclusions: Only approximately half the patients had their EAI prescriptions filled after discharge. Filling rates did not vary by sociodemographic characteristics.

Anaphylactic reactions in adult patients in Southern Israel.

BACKGROUND: Southern Israel is inhabited by Jews and Bedouins. Children from these populations differ in the epidemiology of anaphylactic reactions; however, the effects of ethnicity on the epidemiology of anaphylactic reactions in adults in these populations are unknown. METHODS: Retrospective review of medical records of patients with anaphylactic reactions treated in a single institution during 2008-2012. RESULTS: A total of 192 evaluable cases of anaphylaxis were recorded; 155 (80.7%) anaphylactic reactions occurred in Jews and 37/192 (19.3%) occurred in Bedouins. A trend towards an older mean age of occurrence of anaphylaxis was recorded in Jewish patients compared with Bedouin patients: 48.1 years versus 41.2, respectively (P = 0.053). Anaphylaxis was more common in Jewish female patients than males and more common in Bedouin male patients than females. Overall, 93/155 (60.0%) females in Jewish patients were affected compared with 14/37 (37.8%) in the Bedouin population (P = 0.015). More Jewish patients had more anaphylaxis attributed to food compared with Bedouin patients: 31/155 (20%) versus 2/37 (5.4%) (P = 0.034). The mean yearly incidence of anaphylaxis was similar in Bedouin and Jewish patients: 12.1 ± 5.3 versus 17.6 ± 15.3, respectively (P = 0.466). However, a significant trend towards a higher incidence of anaphylactic reactions was recorded throughout the study years only in Jewish patients (r = 0.906, P = 0.034). CONCLUSIONS: Adult Jewish patients have a significantly higher probability of having anaphylactic reactions due to food compared with Bedouin patients, with females being more affected, and the incidence of anaphylactic reaction is increasing only in the Jewish population. The epidemiology of anaphylactic reactions can differ between populations residing in the same geographical area.

Epidemiology of Anaphylaxis: Contributions From the Last 10 Years.

Knowledge of the epidemiology of anaphylaxis has improved during the last 10 years thanks to the increased number of publications with improved methodological robustness. Consequently, we better understand the distribution and frequency of anaphylaxis and the characteristics of fatal anaphylaxis. We now know that anaphylaxis is more frequent than previously thought (up to 50-103 cases per 100 000 person-years), although the distribution differs with the age group (up to 3 times in patients aged 0-4 years), cause (food-induced anaphylaxis is more frequent in young people, drug-induced and Hymenoptera anaphylaxis in older patients), and geographical area (more prevalent in areas with less sunlight). A controversial and unresolved issue is whether this high incidence of anaphylaxis is a real increase or merely the result of better identification of anaphylaxis by the attending physician. Recurrence of anaphylaxis has been recorded in one-third of cases, although it is the least studied area of the epidemiology of anaphylaxis. Fatal anaphylaxis, on the other hand, has been widely studied. We know that death from anaphylaxis is a rare and extraordinary event (0.12 to 1.06 deaths per million person-years) and more likely in older individuals in the case of drug and Hymenoptera anaphylaxis. Studies conducted during the last 10 years are highly powered since they include large numbers of patients (national records of hospitalized patients) over long time periods (10-20 years) or have been conducted with representative samples of the general population.

Lipid transfer proteins: the most frequent sensitizer in Italian subjects with food-dependent exercise-induced anaphylaxis.

BACKGROUND: Specific food-dependent exercise-induced anaphylaxis (S-FDEIAn) is a distinct form of food allergy in which symptoms are elicited by exercise performed after ingesting food to which the patient has become sensitised. Non-specific FDEIAn (NS-FDEIAn) is a syndrome provoked by exercise performed after ingesting any food. OBJECTIVE: We sought to identify the culprit allergenic molecules in patients with FDEIAn, combining 'classic' allergy testing with an allergenic molecule-based microarray approach for IgE detection. METHODS: All subjects were evaluated who reported at least one episode of anaphylaxis in association with physical exercise performed within 4 h after a meal. We performed skin prick tests (SPT) with commercial food extracts, prick plus prick tests (P + P) with fresh foods (P + P), and serum specific IgE assays by means of both the ImmunoCAP (CAP) and the ISAC 89 microarray system (ISAC). RESULTS: Among our 82 FDEIAn patients, the most frequent suspected foods were tomato, cereals, and peanut. SPT, P + P, and CAP displayed different degrees of sensitivity. Each test disclosed some positivities not discovered by others. Seventy-nine subjects were positive to at least one food (49 to more than 20), whereas three were negative. All suspected foods were positive to at least one of SPT, P + P, and CAP. When tested using the ISAC, 64 (78%) subjects were positive to Pru p 3 [peach lipid transfer protein (LTP)], 13 were positive to other food allergen molecules, and five displayed negative results to all food allergenic molecules. Overall, 79 patients probably had S-FDEIAn and the other 3 NS-FDEIAn. CONCLUSIONS: Multiple food hypersensitivity represents a clinical hallmark of a large percentage of FDEIAn patients. The very high prevalence of IgE to the LTP suggests a role of this allergen group in causing S-FDEIAn.

A population-based epidemiologic study of emergency department visits for anaphylaxis in Florida.

BACKGROUND: Previous population-based analyses of emergency department (ED) visits for anaphylaxis have been limited to small populations in limited geographic areas and focused on children or have included patients who had allergic conditions other than anaphylaxis. OBJECTIVE: We sought to describe the epidemiology and risk factors among patients with anaphylaxis presenting to Florida EDs. METHODS: Two thousand seven hundred fifty-one patients with anaphylaxis were identified for 2005-2006 within ED records by using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and a validated ICD-9-CM-based algorithm. Age- and sex-specific rates were calculated. Regression analyses were used to determine relative risks for anaphylaxis caused by various triggers (food, venom, and medication) and risk factors (age, sex, race, and ethnicity). RESULTS: The highest observed rates were among the youngest male subjects (8.2/100,000 Floridians aged 0-4 years) and among adult female subjects (15-54 years) grouped in 10-year age categories (9.9-10.9/100,000 Floridians). Male and black subjects were 20% and 25%, respectively, more likely to have a food trigger than female and white subjects. White, male, and older subjects were more likely to have an anaphylaxis-related ED visit caused by insect stings. Venom-induced anaphylaxis was more likely in August through October. Children were less likely than those older than 70 years (referent) to have medication-induced anaphylaxis (P < .03). CONCLUSION: This is the only ED-based population study in a US lower-latitude state. The overall rate is considerably lower than other US ED-based population studies. The rates of anaphylaxis by age group differed by sex. Male and black subjects were more likely to have a food trigger.

A population-based epidemiologic analysis of deaths from anaphylaxis in Florida.

BACKGROUND: Previous US population-based epidemiologic studies of anaphylactic deaths have been limited by small populations and/or few deaths. The objective of this study was to determine the 10-year incidence of death from anaphylaxis in Florida and its descriptive epidemiology. METHODS: Patients who died from anaphylaxis from 1996 to 2005 were identified from ICD-9 and ICD-10 codes on death certificates statewide. Age, race and gender-specific anaphylactic death rates were calculated. RESULTS: There were 89 deaths among Florida residents. The individuals with autopsy confirmed diagnoses, and those with clinical diagnoses only, did not differ with regard to race, anaphylactic triggers or the clinical variables of lung and heart disease. Annual death rate for anaphylaxis in Florida was 5.02/10 000 000. The relative risk of death from anaphylaxis was 14.09 for individuals > or =65 years old (P = 0.0000002) and 6.38 for individuals 35-64 years old (P = 0.0019) compared with those who were 5-14 years of age. Deaths among Florida residents that occurred in emergency rooms or outpatient settings were 2.11 times as likely to be anaphylactic deaths than deaths that occurred in inpatient settings (P = 0.0026). The ratios of anaphylactic deaths to total deaths in March and April and in July and August were greater than the ratios for the other bimonthly periods (P = 0.02). CONCLUSION: Death from anaphylaxis in Florida was more likely to occur in older individuals, in an emergency department, and in the months of March and April and July and August.

Epinephrine auto-injector prescriptions as a reflection of the pattern of anaphylaxis in an Asian population.

This study surveyed the prescription patterns of adrenaline auto-injectors (AAs) in Singapore to examine the frequency, triggers, and demographic pattern of anaphylaxis requiring such prescriptions. A 6-year retrospective review of 417 consecutive patients prescribed AAs in Singapore from January 1999 to December 2004, as identified from hospital pharmacy records. There were 417 patients identified, consisting of 295 (70.7%) Singaporeans with the remaining being non-Singaporean residents. Based on population census, the frequency of AA prescriptions was estimated at 1 per 10,000 Singaporeans. Demographic factors associated with AA prescriptions were male gender (OR = 1.361; p = 0.002); minority ethnic groups, which included Eurasians, Caucasians, Koreans, and Japanese (OR = 15.873; p < 0.001); and children <15 years of age (OR = 2.593; p < 0.001). The most common food allergens resulting in AA prescriptions were peanut (41.9%) and shellfish allergy (28.5%). Multiple logistic regression analysis showed that peanut allergy was independently associated with Eurasian ethnicity (OR = 5.045; p = 0.021); and shellfish allergy with Indian ethnicity (OR = 2.757; p = 0.034). The estimated frequency of AA prescriptions in Singapore is relatively low at 0.01%. The incidence of peanut and shellfish allergy in the Asian population appears to differ from that seen in Western populations.