Fleming Jude T, Clark Sunday, Camargo Carlos A, Rudders Susan A
Division of Asthma and Allergy, Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI.
Department of Emergency Medicine, Weill Cornell Medical College, New York, NY.
J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):57-62. doi: 10.1016/j.jaip.2014.07.004. Epub 2014 Sep 8.
Food-induced anaphylaxis (FIA) is potentially life threatening. Prompt administration of epinephrine is universally recommended by current treatment guidelines.
To identify factors associated with early epinephrine treatment for FIA and to specifically examine the association between early epinephrine treatment and hospitalization.
A chart review study conducted at Hasbro Children's Hospital/Rhode Island Hospital. By using the International Classification of Diseases, Ninth Revision codes, we identified all patients who presented to the emergency department with FIA between January 1, 2004, and December 31, 2009. Early epinephrine treatment was defined as receipt of epinephrine before arrival to the emergency department. The independent association between early epinephrine treatment and hospitalization was assessed using logistic regression.
Among the 384 emergency department visits for FIA identified during the study period, 234 patients received epinephrine (61%). Among this subset, most (164 [70%]) received early epinephrine treatment, whereas a smaller number of patients (70 [30%]) first received epinephrine in the emergency department (late treatment). Patients who received early epinephrine treatment were older (7.4 vs 4.3 years; P = .008), were more likely to have a known food allergy (66% vs 34%; P < .001), and were more likely to own an epinephrine autoinjector (80% vs 23%; P < .001). Patients treated early were less likely to be hospitalized (17% vs 43%; P < .001). After adjusting for age, sex, and race, the patients who received early epinephrine treatment remained at significantly decreased risk of hospitalization compared with those who received late epinephrine treatment (odds ratio 0.25 [95% CI, 0.12-0.49]).
In this population, early treatment of FIA with epinephrine was associated with significantly lower risk of hospitalization. Accordingly, this study supports the benefit of prompt administration of epinephrine for the treatment of FIA.
食物诱发的过敏反应（FIA）有潜在生命危险。当前治疗指南普遍推荐迅速给予肾上腺素。
确定与FIA早期肾上腺素治疗相关的因素，并特别研究早期肾上腺素治疗与住院之间的关联。
在哈斯伯罗儿童医院/罗德岛医院进行的一项病历回顾研究。通过使用国际疾病分类第九版编码，我们确定了2004年1月1日至2009年12月31日期间因FIA到急诊科就诊的所有患者。早期肾上腺素治疗定义为在到达急诊科之前接受肾上腺素治疗。使用逻辑回归评估早期肾上腺素治疗与住院之间的独立关联。
在研究期间确定的384次FIA急诊科就诊中，234例患者接受了肾上腺素治疗（61%）。在这个亚组中，大多数（164例[70%]）接受了早期肾上腺素治疗，而较少患者（70例[30%]）在急诊科首次接受肾上腺素治疗（延迟治疗）。接受早期肾上腺素治疗的患者年龄较大（7.4岁对4.3岁；P = 0.008），更有可能有已知食物过敏（66%对34%；P < 0.001），更有可能拥有肾上腺素自动注射器（80%对23%；P < 0.001）。早期接受治疗的患者住院可能性较小（17%对43%；P < 0.001）。在调整年龄、性别和种族后，与接受延迟肾上腺素治疗的患者相比，接受早期肾上腺素治疗的患者住院风险仍显著降低（优势比0.25[95%CI，0.12 - 0.49]）。
在这一人群中，FIA早期用肾上腺素治疗与显著较低的住院风险相关。因此，本研究支持迅速给予肾上腺素治疗FIA的益处。
