Seafood-Induced Anaphylaxis in Children Presenting to Canadian Emergency Departments: Rates, Clinical Presentation and Management

2022-02-13

Background: There are a lack of data on seafood-induced anaphylaxis in children in Canada.

Objective: We aimed to assess the rate, clinical features, and management of seafood-induced anaphylaxis in children presenting to emergency departments across Canada.

Methods: Children with anaphylaxis were recruited at six emergency departments between 2011 and 2020 as part of the Cross-Canada Anaphylaxis REgistry. A standardized form documenting symptoms, triggers, co-morbidities and management was used to collect data.

Results: There were 75 fish-induced and 71 shellfish-induced cases of suspected anaphylaxis, most of which were caused by salmon and shrimp, respectively. Mucocutaneous symptoms were most common, while respiratory symptoms were associated with patients with fish-induced reactions who have comorbid asthma [aOR 1.18 (95%CI, 1.02, 1.36)]. Pre-hospital epinephrine was underutilized (<35%), while in-hospital epinephrine was given to <60% patients. Among those with a known fish or shellfish allergy, pre-hospital epinephrine use was associated with known asthma [aOR 1.39 (95%CI, 1.05, 1.84) and aOR 1.25 (95%CI 1.02, 1.54), respectively]. Among children who were assessed by either skin tests or specific IgE, 36 (76.6%) patients with suspected fish-induced anaphylaxis and 19 (51.4%) patients with suspected shellfish-induced anaphylaxis tested positive.

Conclusion: Pre-hospital epinephrine is underused in the management of seafood-induced anaphylaxis. Among children with known seafood allergy, pre-hospital epinephrine is more likely if there is a known asthma comorbidity.

Authors: Daniel Sehayek, Morgan S Gold, Sofianne Gabrielli, Elissa M Abrams, Adam Bretholz, Edmond S Chan, Derek K Chu, Ann E Clarke, Jennifer Gerdts, Ran D Goldman, Jocelyn Gravel, Elana Hochstadter, Rodrick Lim, Christine McCusker, Jocelyn Moisan, Judy Morris, Andrew O’Keefe, Jennifer L P Protudjer, Greg Shand, Elinor Simons, Julia Upton, Xun Zhang, Moshe Ben-Shoshan
; Full Source: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2022 Feb 13;S1081-1206(22)00097-7. doi: 10.1016/j.anai.2022.02.003.