Milk-Induced Anaphylaxis Among Children Presenting to Canadian Emergency Departments
Notice bibliographique
Résumé
To describe the clinical presentation and management of pediatric patients with milk-induced anaphylaxis in Canadian emergency departments (EDs).This study included 3118 pediatric patients with anaphylaxis from 10 different Canadian EDs between April 2011 and May 2023.Patients were enrolled prospectively through interviews with families and retrospectively by chart review. The clinical courses of patients with anaphylaxis were recorded through a standardized form. The primary objectives were to determine risk factors for receiving 2 or more doses of epinephrine in the ED and to characterize the differences in reactions between patients < 5 years and those 5 years and older, when milk allergy may have resolved.Of the 3118 patients, 319 (10%) presented with milk-induced anaphylaxis. Of these patients, 171 (53.6%) received intramuscular epinephrine before ED arrival. Those with a known food allergy and those who received intramuscular epinephrine before ED arrival were less likely to require 2 or more epinephrine doses in the ED. Patients < 5 years were more likely to have a mild reaction (P = .005) and a faster onset of reaction (<5 minutes) (P = .003). Patients 5 years of age or older were more likely to have a moderate reaction (P = .0004) and a later onset of reaction (5 minutes to 2 hours) (P = .005). When compared with anaphylaxis from other food allergens, milk-induced anaphylaxis patients were younger (P < .001) and more commonly had symptoms of wheezing (P = .005) and vomiting. Epinephrine use in the ED and admission to the ICU was similar between milk-induced versus other food allergen anaphylaxis.Approximately half of patients with milk-induced anaphylaxis did not receive epinephrine before presenting to the ED. Prehospital administration of epinephrine was associated with a decreased risk of requiring 2 or more doses of epinephrine in the ED. This study also demonstrated patients 5 years and older were more likely to have a moderate reaction, suggesting those who do not outgrow their food allergy may experience worse reactions.This is the largest pediatric study on milk-induced anaphylaxis and highlights the importance of recognizing milk as a major cause of anaphylaxis in young children. This study also demonstrates continued underuse of epinephrine outside of the hospital. Further strategies to improve access and use of epinephrine autoinjectors in milk-induced anaphylaxis may decrease the severity and improve patient’s clinical course.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».