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Bartolucci S, Gabrielli S, Clarke A, Chan ES, Upton J, O-Keefe A, Eisman H, Ben-Shoshan M. Management and diagnosis of exercise-associated anaphylaxis cases in the paediatric population. Clin Exp Allergy 2020; 51:148-150. [PMID: 33063898 DOI: 10.1111/cea.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/25/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sabrina Bartolucci
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Ann Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Andrew O-Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Harley Eisman
- Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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Miles BT, Gabrielli S, Clarke A, Eisman H, Shand G, Ben-Shoshan M. Rates of anaphylaxis for the most common food allergies. The Journal of Allergy and Clinical Immunology: In Practice 2020; 8:2402-2405.e3. [DOI: 10.1016/j.jaip.2020.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/24/2022]
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Miles LM, Gabrielli S, Clarke AE, Morris J, Eisman H, Gravel J, Lim R, Hochstadter E, Gerdts J, Upton J, Chu DK, Zhang X, Ben-Shoshan M. When and how pediatric anaphylaxis cases reach the emergency department: Findings from the Cross-Canada Anaphylaxis Registry. J Allergy Clin Immunol Pract 2019; 8:1406-1409.e2. [PMID: 31678292 DOI: 10.1016/j.jaip.2019.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Laura May Miles
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada.
| | - Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, QC, Canada
| | - Harley Eisman
- Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Rodrick Lim
- Division of Pediatrics and Emergency Medicine, Children's Hospital at London Health Science Centre, London, ON, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Julia Upton
- Division of Immunology and Allergy, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Derek K Chu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
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Gabrielli S, Clarke A, Morris J, Eisman H, Gravel J, Enarson P, Chan ES, O'Keefe A, Porter R, Lim R, Yanishevsky Y, Gerdts J, Adatia A, LaVieille S, Zhang X, Ben-Shoshan M. Evaluation of Prehospital Management in a Canadian Emergency Department Anaphylaxis Cohort. J Allergy Clin Immunol Pract 2019; 7:2232-2238.e3. [PMID: 31035000 DOI: 10.1016/j.jaip.2019.04.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/14/2019] [Accepted: 04/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies assessing the use of antihistamines and corticosteroids for the treatment of anaphylaxis have not supported a conclusive effect. OBJECTIVE To assess prehospital management of anaphylaxis by measuring the effect of epinephrine use compared with antihistamines and corticosteroids on negative outcomes of anaphylaxis (intensive care unit/hospital ward admission, multiple doses of epinephrine in the emergency department [ED], and intravenous fluids given in the ED). METHODS The Cross-Canada Anaphylaxis Registry is a cohort study that enrolls anaphylaxis cases presenting to EDs in 5 Canadian provinces over a 6-year period. Participants were recruited prospectively and retrospectively and were excluded if the case did not meet the definition of anaphylaxis. RESULTS A total of 3498 cases of anaphylaxis, of which 80.3% were children, presented to 9 EDs across Canada. Prehospital treatment with epinephrine was administered in 31% of cases, whereas antihistamines and corticosteroids were used in 46% and 2% of cases, respectively. Admission to the intensive care unit/hospital ward was associated with prehospital treatment with corticosteroids (adjusted odds ratio, 2.84; 95% confidence interval [CI], 1.55, 6.97) while adjusting for severity, treatment with epinephrine and antihistamines, asthma, sex, and age. Prehospital treatment with epinephrine (adjusted odds ratio, 0.23; 95% CI, 0.14, 0.38) and antihistamines (adjusted odds ratio, 0.61; 95% CI, 0.44, 0.85) decreased the likelihood of receiving multiple doses of epinephrine in the ED, while adjusting for severity, treatment with corticosteroids, asthma, sex, and age. CONCLUSIONS Prompt epinephrine treatment is crucial. Use of antihistamines in conjunction with epinephrine may reduce the risk of uncontrolled reactions (administration of 2 or more doses of epinephrine in the ED), although our findings do not support the use of corticosteroids.
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Affiliation(s)
- Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Ann Clarke
- Division of Rheumatology, Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada
| | - Harley Eisman
- Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Division of Emergency Medicine, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Paul Enarson
- Division of Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, Canada
| | - Robert Porter
- Division of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, Canada
| | - Rodrick Lim
- Division of Pediatrics and Emergency Medicine, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Yarden Yanishevsky
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Adil Adatia
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Sebastien LaVieille
- Food Directorate, Health Canada, Ottawa, Ontario, Canada; Département sciences des aliments, Faculté des sciences de l'agriculture et de l'alimentation, Université Laval, Québec City, Québec, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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Le M, Gabrielli S, Clarke A, Eisman H, Morris J, Gravel J, Chan ES, Lim R, O'Keefe A, Shand G, Ben-Shoshan M. Emergency Management of Anaphylaxis Due to an Unknown Trigger: An 8-Year Follow-Up Study in Canada. J Allergy Clin Immunol Pract 2018; 7:1166-1173.e1. [PMID: 30476682 DOI: 10.1016/j.jaip.2018.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 12/31/2022]
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 To assess and compare the demographic and clinical characteristics and the management of adult and pediatric AUT cases across Canada. METHODS Participants were identified between 2011 and 2018 in emergency departments at 8 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 AUT cases (7.5%) were recruited among 3,922 cases of anaphylaxis. In the prehospital 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 after 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 4 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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Affiliation(s)
- Michelle Le
- McGill University, Montreal, Quebec, Canada.
| | - Sofianne Gabrielli
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Harley Eisman
- Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Judy Morris
- Department of Emergency Medicine, Hôpital Sacré-Coeur, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Emergency Medicine, Hôpital Sainte-Justine, Montreal, Quebec, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Rod Lim
- Department of Pediatrics and Medicine, Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St John's, Newfoundland, Canada
| | - Greg Shand
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
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Gabrielli S, Clarke A, Morris J, Eisman H, Gravel J, Enarson P, Chan ES, Gerdts J, O'Keefe A, Porter R, Lim R, Yanishevsky Y, Adatia A, Ben-Shoshan M. Teenagers and those with severe reactions are more likely to use their epinephrine autoinjector in cases of anaphylaxis in Canada. J Allergy Clin Immunol Pract 2018; 7:1073-1075.e3. [PMID: 30170165 DOI: 10.1016/j.jaip.2018.07.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/30/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Ann Clarke
- Division of Rheumatology, Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada
| | - Harley Eisman
- Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Division of Emergency Medicine, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Paul Enarson
- Division of Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St John's, Newfoundland & Labrador, Canada
| | - Robert Porter
- Division of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, Newfoundland & Labrador, Canada
| | - Rodrick Lim
- Division of Pediatrics and Emergency Medicine, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Yarden Yanishevsky
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Adil Adatia
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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Tritt A, Gabrielli S, Zahabi S, Clarke A, Moisan J, Eisman H, Morris J, Restivo L, Shand G, Ben-Shoshan M. Short- and long-term management of cases of venom-induced anaphylaxis is suboptimal. Ann Allergy Asthma Immunol 2018; 121:229-234.e1. [PMID: 29656144 DOI: 10.1016/j.anai.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Venom-induced anaphylaxis (VIA) accounts for severe reactions. However, little is known about the short- and long-term management of VIA patients. OBJECTIVE To assess the short- and long-term management of VIA. METHODS Using a national anaphylaxis registry (C-CARE), we identified VIA cases presenting to emergency departments in Montreal and to emergency medical services (EMSs) in western Quebec over a 4-year period. Data were collected on clinical characteristics, triggers, and management. Consenting patients were contacted annually regarding long-term management. Univariate and multivariate logistic regressions were used to identify factors associated with epinephrine use, allergist assessment, and administration of immunotherapy. RESULTS Between June 2013 and May 2017, 115 VIA cases were identified. Epinephrine was administered to 63.5% (95% confidence interval [CI], 53.9%-72.1%) of all VIA cases by a health care professional. Treatment of reactions without epinephrine was more likely in reactions occurring at home and in nonsevere cases (no hypotension, hypoxia, or loss of consciousness). Among 48 patients who responded to a follow-up questionnaire, 95.8% (95% CI, 84.6%-99.3%) were prescribed epinephrine auto-injector, 68.8% (95% CI, 53.6%-80.9%) saw an allergist who confirmed the allergy in 63.6% of cases, and 81.0% of those with positive testing were administered immunotherapy. Among cases with follow-up, seeing an allergist was less likely in patients with known ischemic heart disease. CONCLUSION Almost 30% of patients with suspected VIA did not see an allergist, only two thirds of those seeing an allergist had allergy confirmation, and almost one fifth of those with confirmed allergy did not receive immunotherapy. Educational programs are needed to bridge this knowledge-to-action gap.
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Affiliation(s)
- Ashley Tritt
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sarah Zahabi
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ann Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Moisan
- Regional Medical Director of Emergency Medical Services of Outaouais, Outaouais, Quebec, Canada
| | - Harley Eisman
- Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacre-Coeur Hospital, Montreal, Quebec, Canada
| | - Lea Restivo
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Greg Shand
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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Le M, Clarke AE, Eisman H, Morris J, Gravel J, Chan ES, Lim R, O'Keefe A, Shand G, Ben-Shoshan M. Emergency Management of Pediatric Anaphylaxis due to an Unknown Cause: A 5-year follow-up study in Canada. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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De Schryver S, Clarke A, La Vieille S, Eisman H, Morris J, Lim R, Gravel J, Ben-Shoshan M. Food-induced anaphylaxis to a known food allergen in children often occurs despite adult supervision. Pediatr Allergy Immunol 2017; 28:715-717. [PMID: 28786498 DOI: 10.1111/pai.12770] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah De Schryver
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Ann Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Harley Eisman
- Emergency Department, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Judy Morris
- Department of Emergency Medicine, Hôpital du Sacré-Coeur, Montreal, QC, Canada
| | - Rodrick Lim
- Department of Emergency Medicine, London Health Sciences Center Children's Hospital, London, ON, Canada
| | - Jocelyn Gravel
- Department of Emergency Medicine, Hôpital Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
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Gabrielli S, Clarke AE, Eisman H, Morris J, Joseph L, La Vieille S, Small P, Lim R, Enarson P, Zelcer M, Chan ES, Mill C, Ben-Shoshan M. Disparities in rate, triggers, and management in pediatric and adult cases of suspected drug-induced anaphylaxis in Canada. Immun Inflamm Dis 2017; 6:3-12. [PMID: 29094518 PMCID: PMC5818453 DOI: 10.1002/iid3.201] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Data is sparse on drug-induced anaphylaxis (DIA) and there have not been studies assessing the differences in clinical characteristics and management of DIA between adults and children. OBJECTIVE We assessed the percentage, diagnosis, and management of DIA among all anaphylaxis visits in three pediatric and one adult emergency departments (ED) across Canada. METHODS Children presenting to the Montreal Children's Hospital (MCH), British Columbia Children's Hospital (BCCH), and Children's Hospital at London Health Sciences Center and adults presenting to Hôpital du Sacré-Coeur with anaphylaxis were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized data form documenting the reaction and management was completed and patients were followed annually to determine assessment by allergist and use of confirmatory tests. RESULTS From June 2012 to May 2016, 51 children were recruited from the pediatric centers and 64 adults from the adult center with drug-induced anaphyalxis. More than half the cases were prospectively recruited. The percentage of DIA among all cases of anaphylaxis was similar in all three pediatric centers but higher in the adult center in Montreal. Most reactions in children were triggered by non-antibiotic drugs, and in adults, by antibiotics. The majority of adults and a third of children did not see an allergist after the initial reaction. In those that did see an allergist, diagnosis was established by either a skin test or an oral challenge in less than 20% of cases. CONCLUSIONS Our results reveal disparities in rate, culprit, and management of DIA in children versus adults. Further, most cases of suspected drug allergy are not appropriately diagnosed. Guidelines to improve assessment and diagnosis of DIA are required.
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Affiliation(s)
- Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Harley Eisman
- Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Judy Morris
- Department of Emergency Medicine, Hôpital du Sacré-Coeur, Montreal, Quebec, Canada
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Sebastien La Vieille
- Food Directorate, Health Canada, Ottawa, Ontario, Canada.,Département sciences des aliments, Faculté des sciences de l'agriculture et de l'alimentation, Université Laval, Québec City, Québec, Canada
| | - Peter Small
- Division of Allergy and Clinical Immunology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rodrick Lim
- Department of Paediatrics and Emergency Medicine, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Paul Enarson
- Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michal Zelcer
- Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Mill
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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Alsayegh MA, Alshamali H, Khadada M, Ciccolini A, Ellis AK, Quint D, Powley W, Lee L, Fiteih Y, Baksh S, Vliagoftis H, Gerega SK, Millson B, Charland K, Barakat S, Sun X, Jimenez R, Waserman S, FitzGerald MJ, Hébert J, Cognet-Sicé J, Renahan KE, Huq S, Chooniedass R, Sawyer S, Pasterkamp H, Becker A, Smith SG, Zhang S, Jayasundara K, Tacon C, Simidchiev A, Nadeau G, Gunsoy N, Mullerova H, Albers F, Kim YW, Shannon CP, Singh A, Neighbour H, Larché M, Tebbutt SJ, Klopp A, Vehling L, Becker AB, Subbarao P, Mandhane PJ, Turvey SE, Sears MR, Azad MB, Loewen K, Monchka B, Mahmud SM, Jong G‘, Longo C, Bartlett G, Ducharme FM, Schuster T, MacGibbon B, Barnett T, North ML, Brook J, Lee E, Omana V, Thiele J, Steacy LM, Evans G, Diamond M, Sussman GL, Amistani Y, Abiteboul K, Tenn MW, Yang C, Carlsten C, Conway EM, Mack D, Othman Y, Barber CM, Kalicinsky C, Burke AE, Messieh M, Nair P, Che CT, Douglas L, Liem J, Duan L, Miller C, Dupuis P, Connors LA, Fein MN, Shuster J, Hadi H, Polk B, Raje N, Labrosse R, Bégin P, Paradis L, Roches AD, Lacombe-Barrios J, Mishra S, Lacuesta G, Chiasson M, Haroon B, Robertson K, Issekutz T, Leddin D, Couban S, Connors L, Roos A, Kanani A, Chan ES, Schellenberg R, Rosenfield L, Cvetkovic A, Woodward K, Quirt J, Watson WTA, Castilho E, Sullivan JA, Temple B, Martin D, Cook VE, Mills C, Portales-Casamar E, Fu LW, Ho A, Zaltzman J, Chen L, Vadas P, Gabrielli S, Clarke A, Eisman H, Morris J, Joseph L, LaVieille S, Ben-Shoshan M, Graham F, Barnes C, Portnoy J, Stagg V, Simons E, Lefebvre D, Dai D, Mandhane P, Sears M, Tam H, Simons FER, Alotaibi D, Dawod B, Tunis MC, Marshall J, Desjardins M, Béland M, Lejtenyi D, Drolet JP, Lemire M, Tsoukas C, Noya FJ, Alizadehfar R, McCusker CT, Mazer BD, Maestre-Batlle D, Gunawan E, Rider CF, Bølling AK, Pena OM, Suez D, Melamed I, Hussain I, Stein M, Gupta S, Paris K, Fritsch S, Bourgeois C, Leibl H, McCoy B, Noel M, Yel L, Scott O, Reid B, Atkinson A, Kim VHD, Roifman CM, Grunebaum E, AlSelahi E, Aleman F, Oberle A, Trus M, Sussman G, Kanani AS, Chambenoi O, Chiva-Razavi S, Grodecki S, Joshi N, Menikefs P, Holt D, Pun T, Tworek D, Hanna R, Heroux D, Rosenberg E, Stiemsma L, Turvey S, Denburg J, Mill C, Teoh T, Zimmer P, Avinashi V, Paina M, Darwish Hassan AA, Oliveria JP, Olesovsky C, Gauvreau G, Pedder L, Keith PK, Plunkett G, Bolner M, Pourshahnazari P, Stark D, Vostretsova K, Moses A, Wakeman A, Singer A, Gerstner T, Abrams E, Johnson SF, Woodgate RL. Canadian Society of Allergy and Clinical Immunology annual scientific meeting 2016. Allergy Asthma Clin Immunol 2017. [PMCID: PMC5390240 DOI: 10.1186/s13223-017-0192-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Das D, Rash A, Clarke AE, Moisan J, Chan ES, Eisman H, Ben-Shoshan M. Longitudinal Differences In Treatment Of Anaphylaxis Presenting To Pre-hospital Emergency Services In Rural Quebec. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gabrielli S, Clarke AE, Eisman H, Morris J, Joseph L, LaVieille S, Small P, Ben-Shoshan M. Drug-Induced Anaphylaxis Visits: A 4-Year Follow-up Study in Two Emergency Departments in Montreal. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rash A, Das D, Tardio N, Eisman H, Chan ES, Clarke AE, Ben-Shoshan M. Anaphylaxis During Exercise In A Pediatric Population. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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O'Keefe A, Clarke A, St Pierre Y, Mill J, Asai Y, Eisman H, La Vieille S, Alizadehfar R, Joseph L, Morris J, Gravel J, Ben-Shoshan M. The Risk of Recurrent Anaphylaxis. J Pediatr 2017; 180:217-221. [PMID: 27743592 DOI: 10.1016/j.jpeds.2016.09.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/10/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the recurrence rate of anaphylaxis in children medically attended in an emergency department (ED), we performed a prospective cohort study to evaluate prehospital and ED management of children with recurrent anaphylaxis and to assess factors associated with recurrent anaphylaxis. STUDY DESIGN As part of the Cross-Canada Anaphylaxis Registry, parents of children with anaphylaxis identified prospectively in 3 EDs and through an emergency medical response service were contacted annually after presentation and queried on subsequent reactions. Cox regression analysis determined factors associated with recurrence. RESULTS Among 292 children who were registered as having had medical attended anaphylaxis, 68.5% completed annual follow-up questionnaires. Forty-seven patients experienced 65 episodes of anaphylaxis during 369 patient-years of follow-up. Food was the trigger in 84.6% of cases, and epinephrine was used in 66.2%. In 50.8%, epinephrine was used outside the health care facility, and 81.7% were brought to a health care facility for treatment. Asthma, reaction triggered by food, and use of epinephrine during the index episode increased the odds of recurrent reaction. Patients whose initial reaction was triggered by peanut were less likely to have a recurrent reaction. CONCLUSIONS We report a yearly anaphylaxis recurrence rate of 17.6% in children. There is substantial underuse of epinephrine in cases of anaphylaxis. Educational programs that promote effective avoidance strategies and prompt use of epinephrine are required.
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Affiliation(s)
- Andrew O'Keefe
- Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Ann Clarke
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yvan St Pierre
- Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Jennifer Mill
- Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Yuka Asai
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Harley Eisman
- Montreal Children's Hospital, Emergency Department, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Reza Alizadehfar
- Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Lawrence Joseph
- Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hospital, University of Montréal, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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Lee AY, Enarson P, Clarke AE, La Vieille S, Eisman H, Chan ES, Mill C, Joseph L, Ben-Shoshan M. Anaphylaxis across two Canadian pediatric centers: evaluating management disparities. J Asthma Allergy 2016; 10:1-7. [PMID: 28115856 PMCID: PMC5221795 DOI: 10.2147/jaa.s123053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are no data on the percentage of visits due to anaphylaxis in the emergency department (ED), triggers, and management of anaphylaxis across different provinces in Canada. OBJECTIVE To compare the percentage of anaphylaxis cases among all ED visits, as well as the triggers and management of anaphylaxis between two Canadian pediatric EDs (PEDs). METHODS As part of the Cross-Canada Anaphylaxis Registry (C-CARE), children presenting to the British Columbia Children's Hospital (BCCH) and Montreal Children's Hospital (MCH) EDs with anaphylaxis were recruited. Characteristics, triggers, and management of anaphylaxis were documented using a standardized data entry form. Differences in demographics, triggers, and management were determined by comparing the difference of proportions and 95% confidence interval. RESULTS Between June 2014 and June 2016, there were 346 visits due to anaphylaxis among 93,730 PED visits at the BCCH ED and 631 anaphylaxis visits among 164,669 pediatric visits at the MCH ED. In both centers, the majority of cases were triggered by food (BCCH 91.3% [88.7, 94.0], MCH 82.4% [79.7, 85.3]), of which peanuts were the most common culprit (24.7% [20.9, 29.9] and 19.0% [15.8, 22.7], respectively). Pre-hospital administration of epinephrine (BCCH 27.7% [23.2, 32.8], MCH 33.1% [29.5, 37.0]) and antihistamines (BCCH 50.6% [45.2, 56.0], MCH 47.1% [43.1, 51.0]) was similar. In-hospital management differed in terms of increased epinephrine, antihistamine, and steroid use at the BCCH (59.2% [53.9, 64.4], 59.8% [54.4, 65.0], and 60.1% [54.7, 65.3], respectively) compared to the MCH (42.2% [38.3, 46.2], 36.2% [32.5, 40.1], and 11.9% [9.5, 14.8], respectively). Despite differences in management, percentage of cases admitted to the intensive care unit was similar between the two centers. CONCLUSION Compared to previous European and North American reports, there is a high percentage of anaphylaxis cases in two PEDs across Canada with substantial differences in hospital management practices. It is crucial to develop training programs that aim to increase epinephrine use in anaphylaxis.
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Affiliation(s)
- Alison Ym Lee
- Pediatric Residency Program, Department of Pediatrics, University of British Columbia, BC Children's Hospital
| | - Paul Enarson
- Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | | | - Harley Eisman
- Emergency Department; Department of Pediatrics, Montreal Children's Hospital, Montreal, QC
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC
| | - Christopher Mill
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
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Côté MÈ, Boulay MÈ, Plante S, Chakir J, Boulet LP, Ahmed H, Ospina MB, Sideri K, Vliagoftis H, Johnson SF, Woodgate RL, Cros G, Teira P, Cellot S, Bittencourt H, Decaluwe H, Vachon MF, Duval M, Haddad E, Kim VHD, Pham-Huy A, Grunebaum E, Oliveria JP, Phan S, Tenn MW, Tworek D, Smith SG, Baatjes AJ, Obminski CD, Munoz CE, Scime TX, Sehmi R, Gauvreau GM, Salter BM, Smith SG, Obminski CD, Munoz CE, Schlatman A, Scime TX, Watson R, Sherkat R, Khoshnevisan R, Sheikhbahaei S, Betschel S, Warrington R, Schellenberg R, Fein MN, Pelletier JP, Kan M, Labrosse R, Mak R, Loh J, Kanani A, Nowak DA, Keith PK, Pannozzo D, Lima HC, Pham D, Pham H, Alvarez GG, Bencze IT, Sharma KB, Smith M, Aaron S, Block J, Keays T, Leech J, Schneidermen D, Cameron J, Forgie J, Ring A, O’Quinn JW, Santucci S, Yang WH, Gaudet E, Aaron S, Voisin MR, Borici-Mazi R, Vostretsova K, Stark DF, Yeboah E, Martin-Rhee M, Gula C, Cheng C, Paltser G, Dery A, Clarke A, Nadeau K, Harada L, Weatherall K, Greenwood C, Daley D, Asai Y, Ben-Shoshan M, Ling L, Ospina MB, Protudjer JLP, Vetander M, van Hage M, Olén O, Wickman M, Bergström A, Teoh T, Mill C, Wong T, Baerg I, Alexander A, Hildebrand KJ, Dean J, Kuzeljevic B, Chan ES, Argeny J, Gona-Hoepler M, Fucik P, Nachbaur E, Gruber S, Crameri R, Glaser A, Szépfalusi Z, Rhyner C, Eiwegger T, Plunkett G, Mire B, Yazicioglu M, Can C, Ciplak G, Cook VE, Portales-Casamar E, Nashi EP, Gabrielli S, Primeau MN, Lejtenyi C, Netchiporouk E, Dery A, Shand G, Hoe E, Liem J, Ko JK, Huang DJT, Mazza JA, McHenry M, Otley A, Watson W, Kraft JN, Paina M, Darwish Hassan AA, Heroux D, Crawford L, Gauvreau G, Denburg J, Pedder L, Chad Z, Sussman G, Hébert J, Frankish C, Olynych T, Cheema A, Del Carpio J, Harrison R, Torabi B, Medoff E, Mill J, Quirt JA, Wen X, Kim J, Herrero AJ, Kim HL, Grzyb MJ, Primeau MN, Azad MB, Lu Z, Becker AB, Subbarao P, Mandhane PJ, Turvey SE, Sears MR, Boucher-Lafleur AM, Gagné-Ouellet V, Jacques É, Laprise C, Chen M, McGovern T, Adner M, Martin JG, Cosic N, Ntanda H, Giesbrecht G, Kozyrskyj A, Letourneau N, Dawod B, Marshall J, De Schryver S, Halbrich M, La Vieille S, Eisman H, Alizadehfar R, Joseph L, Morris J, Feldman LY, Thacher JD, Kull I, Melén E, Pershagen G, Protudjer JLP, Hosseini A, Hackett TL, Hirota J, McNagny K, Wilson S, Carlsten C, Huq S, Chooniedass R, Gerwing B, Huang H, Lefebvre D, Becker A, Khamis MM, Awad H, Allen K, Adamko DJ, El-Aneed A, Kim YW, Gliddon DR, Shannon CP, Singh A, Hickey PLC, Ellis AK, Neighbour H, Larche M, Tebbutt SJ, Ladouceur E, Stewart M, Evans J, Masuda J, To T, King M, Larouche M, Liang L, Legere SA, Haidl ID, Legaré JF, Marshall JS, Sears M, Moraes TJ, Ratjen F, Gustafsson P, Lou W, North ML, Lee E, Omana V, Thiele J, Brook J, Rahman T, Lejtenyi D, Fiter R, Piccirillo C, Mazer B, Simons E, Hildebrand K, Turvey S, DeMarco M, Le Cao KA, Gauvreau GM, Mark FitzGerald J, O’Byrne PM, Stiemsma LT, Arrieta MC, Cheng J, Dimitriu PA, Thorson L, Yurist S, Lefebvre DL, Mandhane P, McNagny KM, Kollmann T, Mohn WW, Brett Finlay B, Tran MM, Lefebvre DL, Ramasundarahettige CF, Dai WH, Mandhane PJ, Tworek D, O’Byrne SN, O’Byrne PM, Denburg JA, Walsh L, Soliman M, Steacy LM, Adams DE, Warner L, Mauro MA, Mamonluk R, Yang C, Conway EM. Proceedings of the Canadian society of allergy and clinical immunology annual scientific meeting 2015. Allergy Asthma Clin Immunol 2016. [PMCID: PMC5009563 DOI: 10.1186/s13223-016-0118-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A1 Role of fibrocytes in allergic rhinitis Marie-Ève Côté, Marie-Ève Boulay, Sophie Plante, Jamila Chakir, Louis-Philippe Boulet A2 Patterns of aeroallergens sensitization in Northern Alberta Hanan Ahmed, Maria-Beatriz Ospina, Kyriaki Sideri, Harissios Vliagoftis A3 Addressing acceptable risk for adolescents with Food-Induced Anaphylaxis (FIA) Sara F. Johnson, Roberta L. Woodgate A4 Outcomes of matched related and unrelated bone marrow transplantation after reduced-toxicity conditioning for children suffering from Chronic Granulomatous Disease Guilhem Cros, Pierre Teira, Sonia Cellot, Henrique Bittencourt, Helene Decaluwe, Marie France Vachon, Michel Duval, Elie Haddad A5 Outcomes of patients with severe combined immunodeficiency (SCID) prior to and after initiation of newborn screening for SCID in Ontario Vy H.D. Kim, Anne Pham-Huy, Eyal Grunebaum A6 Detection of regulatory B cells in the airways of subjects with asthma John-Paul Oliveria, Stephanie Phan, Mark W. Tenn, Damian Tworek, Steven G. Smith, Adrian J. Baatjes, Caitlin D. Obminski, Caroline E. Munoz, Tara X. Scime, Roma Sehmi, Gail M Gauvreau A7 Characterization of IgE-expressing B cells in the airways and peripheral blood of allergic asthmatic subjects John-Paul Oliveria, Stephanie Phan, Mark W. Tenn, Brittany M Salter, Steven G Smith, Caitlin D Obminski, Caroline E Munoz, Abbey Schlatman, Tara X Scime, Rick Watson, Roma Sehmi, Gail M Gauvreau A8 Pregnancy: could it be a risk factor for primary immunodeficient patients Roya Sherkat, Razieh Khoshnevisan, Saba Sheikhbahaei A9 Clinical experience with Octagam: a Canadian retrospective chart review Stephen Betschel, Richard Warrington, Robert Schellenberg A10 Kounis syndrome secondary to contrast media with inferior ST elevations and bilateral ischemic stroke Michael N Fein, Jean-Philippe Pelletier A11 Honey bee venom immunotherapy ineffective in bumble bee-induced anaphylaxis: case report and review of literature Manstein Kan, Robert Schellenberg A12 Delayed immune reconstitution occurring after multiple immune complications of hematological stem cell transplantation for a leaky SCID Roxane Labrosse, Guilhem Cros, Pierre Teira, Henrique Bittencourt, Helene Decaluwe, Michel Duval, Elie Haddad A13 Comparison of Three Case Reports of Acquired Angioedema: presentation, management and outcome Raymond Mak, James Loh, Amin Kanani A14 Sitagliptin-associated angioedema not related to concurrent use of ARB or ACE inhibitor Dominik A. Nowak, Paul K. Keith A15 Sneddon-Wilkinson subcorneal pustular dermatosis associated with an IgA monoclonal gammopathy Daniel Pannozzo, Dominik A. Nowak, Hermenio C. Lima A16 Omalizumab can be effective in patients with allergic bronchopulmonary aspergillosis Diana Pham, Hoang Pham, Gonzalo G. Alvarez, Istvan T. Bencze, Krishna B. Sharma, Mark Smith, Shawn Aaron, Jennifer Block, Tara Keays, Judith Leech, David Schneidermen, Jodi Cameron, Jennifer Forgie, Alicia Ring, John W. O’Quinn, Stephanie Santucci, William H. Yang A17 Efficacious use of omalizumab in the treatment of cystic fibrosis Diana Pham, Hoang Pham, Ena Gaudet, Shawn Aaron, Stephanie Santucci, William H. Yang A18 HAE with normal C1-INH with inconsistent response to C1 esterase inhibitor infusion but reliably responsive to icatibant Hoang Pham, Stephanie Santucci, William H. Yang A19 Anaphylaxis reaction to lactase enzyme Mathew R. Voisin, Rozita Borici-Mazi A20 Risk of solid tumor malignancies in patients with primary immune deficiency Kateryna Vostretsova, Donald F. Stark A21 Is it time to adopt the chromogenic assay for measuring C1 esterase inhibitor function in patients with HAE Type 2? Elizabeth Yeboah, Paul K. Keith A22 Emergency department visits for anaphylaxis and allergic reactions Michelle Martin-Rhee, Cheryl Gula, Clare Cheng, Geoff Paltser A23 START: Susceptibility To food Allergies in a Registry of Twins Alizée Dery, Ann Clarke, Kari Nadeau, Laurie Harada, Kimberley Weatherall, Celia Greenwood, Denise Daley, Yuka Asai, Moshe Ben-Shoshan A24 Qualifying the diagnostic approach employed by allergists when managing patients with self-diagnosed non-celiac gluten sensitivity (NCGS) Lee Horgan, Teresa Pun A25 Retrospective analysis on the agreement between skin prick test and serum food specific IgE antibody in adults with suspected food allergy Ling Ling, Maria B. Ospina, Kyriaki Sideri, Harissios Vliagoftis A26 Staple food hypersensitivity from infancy to adolescence: a report from the BAMSE cohort Jennifer L.P. Protudjer, Mirja Vetander, Marianne van Hage, Ola Olén, Magnus Wickman, Anna Bergström A27 Evaluating the impact of supervised epinephrine autoinjector administration during food challenges on perceived parent confidence Timothy Teoh, Christopher Mill, Tiffany Wong, Ingrid Baerg, Angela Alexander, Kyla J. Hildebrand, John Dean, Boris Kuzeljevic, Edmond S. Chan A28 Local immunoglobulin production to Aspergillus fumigatus cystic fibrosis Jonathan Argeny, Mia Gona-Hoepler, Petra Fucik, Edith Nachbaur, Saskia Gruber, Reto Crameri, Andreas Glaser, Zsolt Szépfalusi, Claudio Rhyner, Thomas Eiwegger A29 Extract consumption with skin prick test (SPT) devices Greg. Plunkett, Brad Mire A30 Evaluation of our cases with nonsteroidal anti-inflammatory drug reactions Mehtap Yazicioglu, Ceren Can, Gokce Ciplak A31 Reasons for referral and final diagnoses in a tertiary care pediatric allergy clinic Victoria E. Cook, Kyla J. Hildebrand, Elodie Portales-Casamar, Christopher Mill, Edmond S. Chan A32 Internist referral practices for inpatients with self-reported penicillin allergies at a tertiary care teaching hospital Michael N Fein, Emil P Nashi A33 Assessing the risk of reactions in children with a negative oral challenge after a subsequent use of amoxicillin Sofianne Gabrielli, Christopher Mill, Marie-Noel Primeau, Christine Lejtenyi, Elena Netchiporouk, Alizee Dery, Greg Shand, Moshe Ben-Shoshan A34 Validity of self-reported penicillin allergies Erica Hoe, Joel Liem A35 Effectiveness of allergy-test directed elimination diets in eosinophilic esophagitis Jason K. Ko, David J.T. Huang, Jorge A. Mazza A36 Allergy testing and dietary management in pediatric eosinophilic esophagitis (EoE): A retrospective review of a tertiary Canadian centre’s experience Mary McHenry, Anthony Otley,Wade Watson A37 Visualizing the impact of atopic and allergic skin disease Dominik A. Nowak, John N. Kraft A38 Cystic fibrosis with and without nasal polyposis in pediatric patients: a cross-sectional comparative study Mihaela Paina, Ahmed A. Darwish Hassan, Delia Heroux, Lynn Crawford, Gail Gauvreau, Judah Denburg, Linda Pedder, Paul K. Keith A39 Evaluation of macrolide antibiotic hypersensitivity: the role of oral challenges in children Bahar Torabi, Marie-Noel Primeau, Christine Lejtenyi, Elaine Medoff, Jennifer Mill, Moshe Ben-Shoshan A40 Venom allergy testing: is a graded approach necessary? Jaclyn A. Quirt, Xia Wen, Jonathan Kim, Angel Jimenez Herrero, Harold L. Kim A41 The role of oral challenges in evaluating cephalosporin hypersensitivity reactions in children Magdalena J. Grzyb, Marie-Noël Primeau, Christine Lejtenyi, Elaine Medoff, Jennifer Mill, Moshe Ben-Shoshan A42 Breastfeeding and infant wheeze, atopy and atopic dermatitis: findings from the Canadian Healthy Infant Longitudinal Development Study Meghan B. Azad, Zihang Lu, Allan B. Becker, Padmaja Subbarao, Piushkumar J. Mandhane, Stuart E. Turvey, Malcolm R. Sears, the CHILD Study Investigators A43 IL33 DNA methylation in bronchial epithelial cells is associated to asthma Anne-Marie Boucher-Lafleur, Valérie Gagné-Ouellet, Éric Jacques, Sophie Plante, Jamila Chakir, Catherine Laprise A44 NRF2 mediates the antioxidant response to organic dust-induced oxidative stress in bronchial epithelial cells Michael Chen, Toby McGovern, Mikael Adner, James G. Martin A45 The effects of perinatal distress, immune biomarkers and mother-infant interaction quality on childhood atopic dermatitis (rash) at 18 months Nela Cosic, Henry Ntanda, Gerald Giesbrecht, Anita Kozyrskyj, Nicole Letourneau A46 Examining the immunological mechanisms associated with cow’s milk allergy Bassel Dawod, Jean Marshall A47 Tryptase levels in children presenting with anaphylaxis to the Montréal Children’s Hospital Sarah De Schryver, Michelle Halbrich, Ann Clarke, Sebastian La Vieille, Harley Eisman, Reza Alizadehfar, Lawrence Joseph, Judy Morris, Moshe Ben-Shoshan A48 Secondhand tobacco smoke exposure in infancy and the development of food hypersensitivity from childhood to adolescence Laura Y. Feldman, Jesse D. Thacher, Inger Kull, Erik Melén, Göran Pershagen, Magnus Wickman, Jennifer L. P. Protudjer, Anna Bergström A49 Combined exposure to diesel exhaust and allergen enhances allergic inflammation in the bronchial submucosa of atopic subjects Ali Hosseini, Tillie L. Hackett, Jeremy Hirota, Kelly McNagny, Susan Wilson, Chris Carlsten A50 Comparison of skin-prick test measurements by an automated system against the manual method Saiful Huq, Rishma Chooniedass, Brenda Gerwing, Henry Huang, Diana Lefebvre, Allan Becker A51 The accurate identification and quantification of urinary biomarkers of asthma and COPD through the use of novel DIL- LC-MS/MS methods Mona M. Khamis, Hanan Awad, Kevin Allen, Darryl J. Adamko, Anas El-Aneed A52 Systemic immune pathways associated with the mechanism of Cat-Synthetic Peptide Immuno-Regulatory Epitopes, a novel immunotherapy, in whole blood of cat-allergic people Young Woong Kim, Daniel R. Gliddon, Casey P. Shannon, Amrit Singh, Pascal L. C. Hickey, Anne K. Ellis, Helen Neighbour, Mark Larche, Scott J. Tebbutt A53 Reducing the health disparities: online support for children with asthma and allergies from low-income families Erika Ladouceur, Miriam Stewart, Josh Evans, Jeff Masuda, Nicole Letourneau, Teresa To, Malcolm King A54 Epigenetic association of PSORS1C1 and asthma in the Saguenay-Lac-Saint-Jean asthma study Miriam Larouche, Liming Liang, Catherine Laprise A55 IL-33 induces cytokine and chemokine production in human mast cells Stephanie A. Legere, Ian D. Haidl, Jean-Francois Legaré, Jean S. Marshall A56 Reference ranges for lung clearance index from infancy to adolescence for Canadian population Zihang Lu, Malcolm Sears, Theo J. Moraes, Felix Ratjen, Per Gustafsson, Wendy Lou, Padmaja Subbarao A57 Kingston Allergy Birth Cohort: cohort profile and mother/child characteristics to age 2 Michelle L. North, Elizabeth Lee, Vanessa Omana, Jenny Thiele, Jeff Brook, Anne K. Ellis A58 Cow’s milk protein specific IgE, IgA and IgG4 as a predictor of outcome in oral immunotherapy Tanvir Rahman, Duncan Lejtenyi, Sarah De Schryver, Ryan Fiter, Ciriaco Piccirillo, Moshe Ben-Shoshan, Bruce Mazer A59 Age of peanut introduction and development of reactions and sensitization to peanut Elinor Simons, Allan B. Becker, Rishma Chooniedass, Kyla Hildebrand, Edmond S. Chan, Stuart Turvey, Padmaja Subbarao, Malcolm Sears A60 Multi-omic blood biomarker signatures of the late phase asthmatic response Amrit Singh, Casey P. Shannon, Young Woong Kim, Mari DeMarco, Kim-Anh Le Cao, Gail M. Gauvreau, J. Mark FitzGerald, Louis-Philippe Boulet, Paul M. O’Byrne, Scott J. Tebbutt A61 Early life gut microbial alterations in children diagnosed with asthma by three years of age Leah T. Stiemsma, Marie-Claire Arrieta, Jasmine Cheng, Pedro A. Dimitriu, Lisa Thorson, Sophie Yurist, Boris Kuzeljevic, Diana L. Lefebvre, Padmaja Subbarao, Piush Mandhane, Allan Becker, Malcolm R. Sears, Kelly M. McNagny, Tobias Kollmann, the CHILD Study Investigators, William W. Mohn, B. Brett Finlay, Stuart E. Turvey A62 The relationship between food sensitization and atopic dermatitis at age 1 year in a Canadian birth cohort Maxwell M. Tran, Diana L. Lefebvre, Chinthanie F. Ramasundarahettige, Allan B. Becker, Wei Hao Dai, Padmaja Subbarao, Piush J. Mandhane, Stuart E. Turvey, Malcolm R. Sears A63 Allergen inhalation enhances Toll-like receptor-induced thymic stromal lymphopoietin receptor expression by hematopoietic progenitor cells in mild asthmatics Damian Tworek, Delia Heroux, Seamus N. O’Byrne, Paul M. O’Byrne, Judah A. Denburg A64 The Allergic Rhinitis Clinical Investigator Collaborative – replicated eosinophilia on repeated cumulative allergen challenges in nasal lavage samples Laura Walsh, Mena Soliman, Jenny Thiele, Lisa M. Steacy, Daniel E. Adams, Anne K. Ellis A65 The CHILD Study: optimizing subject retention in pediatric longitudinal cohort research Linda Warner, Mary Ann Mauro, Robby Mamonluk, Stuart E. Turvey A66 Differential expression of C3a and C5a in allergic asthma ChenXi Yang, Amrit Singh, Casey P. Shannon, Young Woong Kim, Ed M. Conway, Scott J. Tebbutt
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Lee AYM, Enarson P, Clarke A, La Vieille S, Eisman H, Chan ES, Mill C, Joseph L, Ben-Shoshan M. Comparison of Pediatric Anaphylaxis at Montreal Children's Hospital and British Columbia Children's Hospital: Rate, Clinical Characteristics, Triggers and Management. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Balram B, Clarke A, La Vieille S, Alizadehfar R, Dery A, Mill C, Eisman H, Morris J, Gravel J, Roches AD, Ben-Shoshan M. C-Care: Patient Characteristics Associated with Allerject TM Versus EpipenTM Auto-Injector Prescription Across Three Montreal Hospitals. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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De Schryver S, Clarke AE, La Vieille S, Alizadehfar R, Dery A, Mill C, Joseph L, Eisman H, Morris J, Ben-Shoshan M. C-Care: Impact of Labeling in Food Induced Anaphylaxis in Children Treated at the Montreal Children's Hospital. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Halbrich M, Clarke A, La Vieille S, Eisman H, Alizadehfar R, Joseph L, Morris J, Ben-Shoshan M. Tryptase Levels in Children Presenting with Anaphylaxis to the Montreal Children's Hospital -2014 Update. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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O'Keefe A, St. Pierre Y, Mill C, Mill J, Dery A, Asai Y, Eisman H, La Vieille S, Alizadehfar R, Joseph L, Morris J, Clarke A, Ben-Shoshan M. Recurrence Rates of Anaphylaxis in Children. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hochstadter E, Clarke A, LaVieille S, Alizadehfar R, Mill C, Asai Y, Eisman H, Ben-Shoshan M. 205: C-Care: Comparing Two Years of Anaphylaxis in a Canadian Pediatric Emergency Department. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Halbrich M, Clarke A, La Vieille S, Eisman H, Alizadehfar R, Lawrence J, Mill C, Morris J, Ben-Shoshan M. Tryptase levels in children presenting with anaphylaxis to the Montreal Children’s Hospital. Allergy Asthma Clin Immunol 2014. [PMCID: PMC4126050 DOI: 10.1186/1710-1492-10-s1-a66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hochstadter E, Clarke A, LaVieille S, Alizadehfar R, Mill C, Asai Y, Eisman H, Ben-Shoshan M. C-CARE: comparing two years of anaphylaxis in children treated at the Montreal Children’s Hospital. Allergy Asthma Clin Immunol 2014. [PMCID: PMC4126010 DOI: 10.1186/1710-1492-10-s1-a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ben-Shoshan M, La Vieille S, Eisman H, Alizadehfar R, Mill C, Perkins E, Joseph L, Morris J, Clarke A. Anaphylaxis treated in a Canadian pediatric hospital: Incidence, clinical characteristics, triggers, and management. J Allergy Clin Immunol 2013; 132:739-741.e3. [PMID: 23900056 DOI: 10.1016/j.jaci.2013.06.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/31/2013] [Accepted: 06/14/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada.
| | | | - Harley Eisman
- Department of Emergency Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Reza Alizadehfar
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | - Christopher Mill
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Emma Perkins
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Lawrence Joseph
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada; Department of Epidemiology and Biostatistics, McGill University Health Center, Montreal, Quebec, Canada
| | - Judy Morris
- Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Ann Clarke
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada; Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
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Ben-Shoshan M, La Vieille S, Eisman H, Alizadehfar R, Perkins E, Joseph L, Morris J, Clarke AE. Anaphylaxis in Children Treated At the Montreal Children's Hospital: Rate, Clinical Characteristics, Triggers and Management. J Allergy Clin Immunol 2013. [DOI: 10.1016/j.jaci.2012.12.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Halbrich M, Clarke AE, La Vieille S, Eisman H, Alizadehfar R, Joseph L, Morris J, Ben-Shoshan M. Tryptase Levels in Children Presenting with Anaphylaxis to the Montreal Children's Hospital. J Allergy Clin Immunol 2013. [DOI: 10.1016/j.jaci.2012.12.1429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Desjardins M, Clarke A, Alizadehfar R, Grenier D, Eisman H, Carr S, Vander Leek T, Teperman L, Higgins N, Joseph L, Shand G, Ben-Shoshan M. Comparison between Allergists and Non-allergists on Issues Related to Food-induced Anaphylaxis. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
The impact of treatment given upon discharge on the "bounce back" rate was ascertained in children presenting at the emergency department for treatment of status migrainosus. All children ages 8 to 17 years old presenting to an emergency department in 2008 who were treated for status migrainosus and discharged home were included. Of the total of 187 patients, 21 patients (11.2%) bounced back. Treatment given was not associated with the bounce back rate. The only factors reaching significance were the presence of a migraine equivalent in 28.6% of patients who bounced back as compared with only 6.7% in patients without recurrence (P = .006); brain imaging study in the emergency department (52.4% vs. 16.9%, P = .001); and an arranged physician follow-up (66.6% vs. 36.3%, P = .01). The results appear to suggest that no current treatment given to children presenting to the emergency department with status migrainosus seems to alter the immediate recurrence rate.
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Affiliation(s)
- Geneviève Legault
- Department of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada
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Karounis H, Gouin S, Eisman H, Chalut D, Pelletier H, Williams B. A Randomized, Controlled Trial Comparing Long-term Cosmetic Outcomes of Traumatic Pediatric Lacerations Repaired with Absorbable Plain Gut versus Nonabsorbable Nylon Sutures. Acad Emerg Med 2004; 11:730-5. [PMID: 15231459 DOI: 10.1197/j.aem.2003.12.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To show that the use of absorbable sutures in pediatric traumatic lacerations affords good long-term cosmesis and no increase in complications (infection, dehiscence rates, and need for surgical scar revision) when compared with wounds sutured with nonabsorbable sutures. METHODS This was a randomized clinical trial conducted in a pediatric emergency department. Patients 1-18 years of age who presented to the emergency department with lacerations < 12 hours old were recruited between January 1999 and December 2001. Exclusion criteria were the following: wounds that could be approximated by tissue adhesives, animal/human bites, gross contamination, puncture/crush wounds, wounds crossing joints, lacerations of tendon/nerve/cartilage, collagen vascular disease, immunodeficiency, diabetes mellitus, bleeding disorder, and scalp lacerations. Patients were randomized into one of two groups: those receiving absorbable plain gut sutures (group A) and those receiving nonabsorbable nylon sutures (group NA). Board-eligible/certified pediatric emergency physicians or clinical fellows performed laceration repair in a standardized approach. All wounds were reevaluated within ten days by a single research nurse who assessed the wounds using a previously validated wound evaluation score (WES) composed of six items (presence of step-off, contour irregularities, margin separation, edge inversion, extensive distortion, and overall cosmetic appearance). A score of 6/6 was considered optimal. The study nurse also noted the presence of infection and dehiscence. The patients were then seen by a single blinded plastic surgeon at four or five months who evaluated the wound using a previously validated visual analog scale of cosmesis (VAS). In addition, the surgeon repeated the WES and assessed the need for surgical scar revision. RESULTS A total of 147 patients were eligible, and 52 patients declined to participate. Of the 95 patients enrolled, 50 were randomized to group A and 45 to group NA. The two groups had similar ages, gender distributions, rates of use of sedation or steri-strips, wound lengths and widths, mechanisms of injury, and wound locations. At the short-term follow-up, no difference was found in the proportion of optimal WES scores between group A (63% of patients) and group NA (49% of patients) (relative risk = 0.73; 95% confidence interval [95% CI] = 0.45 to 1.17). No difference was found in the rates of infection and dehiscence between the two groups. Sixty-three of the 95 patients presented for long-term follow-up. The groups remained similar with respect to patient and wound characteristics as well as wound location. The average VAS score at four months was 79 (95% CI = 73 to 85) for group A and 66 (95% CI = 55 to 76) for group NA. In addition, no differences were found in the proportion of optimal WES between group A (36% of patients) and group NA (28% of patients) at four months (relative risk = 0.88; 95% CI = 0.62 to 1.26). Surgical scar revision was recommended for only three patients, of whom two were in group A. No patients chose to have their scars revised. No differences were found between group A and group NA for the rates of dehiscence (2% vs. 11%; p = 0.07) and infection (0 vs. 2; p = 0.3). CONCLUSIONS The use of plain catgut absorbable sutures in the repair of traumatic lacerations in children appears to be an acceptable alternative to nonabsorbable sutures because the long-term cosmetic outcome seems to be at least as good. In this study, plain gut suture material seemed to provide slightly better cosmesis. In addition, no difference was found in the rate of dehiscence or infection between the groups.
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Affiliation(s)
- Helen Karounis
- Division of Emergency Medicine, Department of Pediatrics, The Montreal Children's Hospital, McGill University, Quebec, Canada.
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Karounis H, Gouin S, Eisman H, Chalut D, Pelletier H, Williams B. A Randomized, Controlled Trial Comparing Long-term Cosmetic Outcomes of Traumatic Pediatric Lacerations Repaired with Absorbable Plain Gut versus Nonabsorbable Nylon Sutures. Acad Emerg Med 2004. [DOI: 10.1111/j.1553-2712.2004.tb00736.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Karounis H, Gouin S, Eisman H, Chalut D, Pusic M, Morin I, Williams B. Plain Gut Versus Non-Absorbable Nylon Sutures in Traumatic Pediatric Lacerations: Long-Term Outcomes. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.58ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Two hundred eight children of Holocaust survivors who were born after their parents' Holocaust experience (children of survivors; COS) and 70 children of parents who left Europe after Hitler's rise to power in 1933 but managed to escape or avoid the Holocaust (children of escapees; COE) were recruited from various Jewish organizations. Research was conducted using questionnaires that were returned by mail. Measures of stress resilience (Kobasa, 1982; Kobasa & Puccetti, 1983), locus of control (Nowicki-Strickland, 1973), and religion (Jewish identity) were administered to all participants. The COS were found to have less resistance to stress and to identify less with feelings of being Jewish. The appropriateness of using COE as a control group and the difficulty of incorporating the unique experiences of the parents into a research study about the intergenerational transmission of coping style is discussed.
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Affiliation(s)
- L Baron
- Coney Island Hospital, Broklyn, NY 11235, USA
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