Robinson Lacey B, Arroyo Anna Chen, Faridi Mohammad K, Rudders Susan, Camargo Carlos A
Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Division of Pulmonary, Allergy and Critical Care Medicine, Stanford School of Medicine, Stanford, Calif.
J Allergy Clin Immunol Pract. 2021 May;9(5):1931-1938.e2. doi: 10.1016/j.jaip.2021.01.010. Epub 2021 Jan 21.
Anaphylaxis is a potentially life-threatening allergic reaction. The overall prevalence of anaphylaxis appears to be rising in children, but temporal trends among infants and toddlers are not well studied.
To characterize the trends in US emergency department (ED) visits and hospitalizations among infants and toddlers with anaphylaxis from 2006 to 2015.
We conducted a study of temporal trends in anaphylaxis among children (age <18 years) and, more specifically, infants and toddlers (age <3 years) presenting to the ED between 2006 and 2015 using a large, nationally representative database. For internal consistency, we defined anaphylaxis using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and excluded visits with International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes (late 2015). We calculated trends in the number and proportion of ED visits and hospitalizations and used multivariable logistic regression to identify predictors of hospitalization.
Among infants and toddlers, the proportion of ED visits for anaphylaxis per year increased from 20 per 100,000 visits to 50 per 100,000 visits (P < .001). The rate of ED visits for anaphylaxis increased from 15 to 32 ED visits per 100,000 population of infants and toddlers (P < .001). Food was the most commonly identified trigger. The proportion of hospitalization among anaphylaxis-related ED visits decreased from 19% to 6% (P < .001). Among ED patients, those more likely to be hospitalized were male, privately insured, from higher income families, and presenting to urban, metropolitan teaching hospital EDs.
In a large, nationally representative US database, from 2006 to 2015, ED visits by infants and toddlers with anaphylaxis increased, whereas hospitalization of these patients decreased.
过敏反应是一种可能危及生命的过敏反应。儿童中过敏反应的总体患病率似乎在上升，但婴幼儿中的时间趋势尚未得到充分研究。
描述2006年至2015年美国婴幼儿过敏反应患者急诊就诊和住院的趋势。
我们使用一个大型的、具有全国代表性的数据库，对2006年至2015年间前往急诊就诊的儿童（年龄<18岁），更具体地说是婴幼儿（年龄<3岁）的过敏反应时间趋势进行了研究。为确保内部一致性，我们使用《国际疾病分类，第九版，临床修订本》诊断代码定义过敏反应，并排除使用《国际疾病分类，第十版，临床修订本》诊断代码（2015年末）的就诊病例。我们计算了急诊就诊和住院的数量及比例趋势，并使用多变量逻辑回归来确定住院的预测因素。
在婴幼儿中，每年因过敏反应而急诊就诊的比例从每10万次就诊中的20次增加到50次（P<.001）。每10万婴幼儿人群中因过敏反应而急诊就诊的比率从15次增加到32次（P<.001）。食物是最常见的诱发因素。与过敏反应相关的急诊就诊中住院的比例从19%降至6%（P<.001）。在急诊患者中，更有可能住院的是男性、有私人保险、来自高收入家庭且前往城市的大都市教学医院急诊就诊的患者。
在一个大型的、具有全国代表性的美国数据库中，2006年至2015年期间，婴幼儿因过敏反应而急诊就诊的次数增加，而这些患者的住院次数减少。
