Food, drug, insect sting allergy, and anaphylaxis
Analysis of food-allergic and anaphylactic events in the National Electronic Injury Surveillance System

https://doi.org/10.1016/j.jaci.2007.10.012Get rights and content

Background

The National Electronic Injury Surveillance System (NEISS) captures a nationally representative probability sample from hospital emergency departments (EDs) in the United States.

Objective

Emergency department data from NEISS were analyzed to assess the magnitude and severity of adverse events attributable to food allergies.

Methods

Emergency department events describing food-related allergic symptomatology were identified from 34 participating EDs from August 1 to September 30, 2003.

Results

Extrapolation of NEISS event data predicts a total of 20,821 hospital ED visits, 2333 visits for anaphylaxis, and 520 hospitalizations caused by food allergy in the United States during the 2-month study period. The median age was 26 years; 24% of visits involved children ≤5 years old. Shellfish was the most frequently implicated food in persons ≥6 years old, whereas children ≤5 years old experienced more events from eggs, fruit, peanuts, and tree nuts. There were no reported deaths. Review of medical records found that only 19% of patients received epinephrine, and, using criteria established by a 2005 anaphylaxis symposium, 57% of likely anaphylactic events did not have an ED diagnosis of anaphylaxis.

Conclusion

Analysis of NEISS data may be a useful tool for assessing the magnitude and severity of food-allergic events. A criteria-based review of medical records suggests underdiagnosis of anaphylactic events in EDs.

Section snippets

The NEISS Database

The NEISS currently collects data from 98 hospital EDs geographically dispersed throughout the US that have a minimum of 6 beds and that provide 24-hour emergency services, excluding psychiatric and penal institutions. On the basis of NEISS sample design and implementation,2, 3 the data ascertained by the system represent a stratified probability sample that can be weighted to produce national estimates of the number of adverse events treated in US EDs.3

In this pilot study, we used 2 months of

Results

Overall, a total of 1161 food-related events were ascertained by NEISS from 34 participating EDs for the period August 1 through September 30, 2003. Although a total of 806 (69 %) events were accompanied by 1 or more key words that suggested a possible allergic etiology, only 173 (15%) met the criteria to be considered food-allergic events, 118 of which reported “allergy” or “allergic reaction,” and 141 of which had accompanying medical records. The excluded events comprised 419 events that

Discussion

Accurate assessment of the nature and incidence of severe food allergy––related reactions is needed for monitoring the public health effect of food allergy and for focusing resources on important preventative strategies. It is evident that many severe food-allergic reactions, including anaphylaxis, present to EDs. Thus, NEISS data, which are made up of nationally representative ED information on consumer product–associated injuries, can be used to obtain clinically and epidemiologically

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    Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

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