March 18, 2022

2 min read

Source / Disclosures

Disclosures: Sehayek reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.


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Epinephrine appeared underused in the management of children with seafood-induced anaphylaxis before they reached the hospital, according to a study published in Annals of Allergy, Asthma & Immunology.

Daniel Sehayek, an MD candidate at Université Laval in Québec, and colleagues reviewed the cases of 146 children aged 18 years and younger who presented with seafood-induced cases of suspected anaphylaxis at six emergency departments recruited through the Cross-Canada Anaphylaxis Registry between 2011 and 2020.

Data taken from Sehayek D, et al. Ann Allergy Asthma Immunol. 2022; doi: 10.1016 / j.janai.2022.02.003.

Overall, 75 of the children (51.4%; boys, n = 40; median age, 4 years; interquartile range [IQR]2.4-8.86) experienced fish-induced anaphylaxis, primarily due to salmon in 16 cases (21.3%), and 71 (48.6%; boys, n = 39; median age, 8.2 years; IQR, 3.65-13.6) had shellfish- induced anaphylaxis, primarily due to shrimp in 50 cases (70.4%).

Most cases of fish-induced and shellfish-induced anaphylaxis were classified as moderate (61.3%; 74.6%), with mild (32%; 21.1%) and severe (6.7%; 4.23%) cases also tallied.

Symptoms in these cases were mucocutaneous (fish, 94.7%; shellfish, 97.2%), respiratory (54.7%; 62%) gastrointestinal (45.3%; 49.3%) and cardiovascular (1.33%; 2.8%).

Twenty-seven of the children reacting to fish (36%) had a known fish allergy, and 16 children reacting to shellfish (22.5%) had a known shellfish allergy.

Patients with comorbid asthma were more likely to experience respiratory symptoms with fish-induced reactions (adjusted OR = 1.18; 95% CI, 1.02-1.36).

Once reactions began, 34.7% of those with fish-induced anaphylaxis received prehospital epinephrine, 40% received in-hospital epinephrine and 30.7% received no epinephrine.

Of the patients with shellfish-induced anaphylaxis, 16.9% received prehospital epinephrine, 57.7% received in-hospital epinephrine and 26.8% received no epinephrine.

Thirteen patients with a known fish allergy (48.1%) and five children with a known shellfish allergy (31.3%) used an epinephrine autoinjector before arriving at the hospital.

One patient with a fish-induced reaction (1.3%) and one patient with a shellfish-induced reaction (1.4%) were admitted to a hospital ward, and one patient with a shellfish-induced reaction (1.4%) was admitted to the ICU .

Patients with a shellfish allergy history were less likely to experience reactions at home (aOR = 0.79; 95% CI, 0.65-0.97), whereas patients with a fish allergy history were more likely to have comorbid asthma (aOR = 1.64; 95% CI , 1.15-2.36).

The researchers also found an association between use of epinephrine and known asthma among patients with a known fish allergy (aOR = 1.39; 95% CI, 1.05-1.84) and patients with a known shellfish allergy (aOR = 1.25; 95% CI, 1.02 -1.54).

According to the researchers, the underuse of epinephrine autoinjectors in prehospital settings highlights the need among patients, parents and prehospital personnel for educational programs to increase their use in all anaphylaxis cases.

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