Emergency Management of Anaphylaxis due to an Unknown Trigger: An 8-year follow-up study in Canada

Publication date: Available online 23 November 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Michelle Le, Sofianne Gabrielli, Ann Clarke, Harley Eisman, Judy Morris, Jocelyn Gravel, Edmond S. Chan, Rod Lim, Andrew O'Keefe, Greg Shand, Moshe Ben-Shoshan

Abstract

Background

Anaphylaxis due to Unknown Trigger (AUT) is anaphylaxis not explained by a proved or presumptive cause or stimulus at the time of the reaction. Research describing the management and follow-up of AUT is limited.

Objective

This study assesses and compares the demographics, clinical characteristics and management of adult and pediatric AUT cases across Canada.

Methods

Participants were identified between 2011 and 2018 in emergency departments at eight centers across Canada as part of the Cross-Canada Anaphylaxis Registry. A standardized form documenting the reaction and management in children and adults was completed. Patients were contacted for follow-up to determine assessment by an allergist.

Results

A total of 295 (7.5%) AUT cases were recruited among 3,922 cases of anaphylaxis. In the pre-hospital setting, children (adjusted Odds Ratio (aOR): 1.20 [95%CI: 1.05, 1.37]) and those with a known food allergy (aOR: 1.14 [95%CI: 1.02, 1.28]) were more likely to receive treatment with epinephrine. Children were also more likely to be assessed by an allergist following their reaction (aOR:1.43 [95%CI: 1.13, 1.81]) and were more likely to have an identified trigger for their reaction (aOR:1.35 [95%CI: 1.07, 1.70]). Among patients contacted for follow-up, food was identified as the cause of reaction in 11 of 76 patients. A new food allergy was diagnosed in four patients (2 children and 2 adults).

Conclusions

Our findings highlight important differences between management and follow-up of adult and pediatric AUT cases. It is crucial to follow up all cases of AUT and establish appropriate treatment and management guidelines.

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