Accidental Food Reactions Requiring Emergency Department Evaluation in Children with Food Allergy are Rare

The rate of emergency department (ED) visits due to food allergy (FA) reactions including anaphylaxis is increasing, yet in children with FA, the exact rate of accidental FA reactions (AFARs) requiring ED evaluation is not definitively known. We identified all children seen in our hospital’s ED between January 1, 2014 and December 31, 2017 with food-related allergic reactions or anaphylaxis by billing code. Charts were reviewed by two pediatric allergy physicians to confirm billing diagnosis. Yearly and 4-year incidence proportions for AFARs were estimated in children with home address within 6 contiguous zip codes previously identified for which >90% would preferentially be referred to our ED and using an established FA prevalence rate in our population. Fisher’s exact test was used to compare incidence between 2014 and 2017. A total of 316 charts were reviewed with 170 deemed inconsistent with a food-induced allergic reaction. Of the 168 cases consistent with IgE-mediated FA, 91 (54.2%) were considered AFARs. The 4-year incidence of AFARs was 0.49% (95% CI, 0.39-0.6%) with no significant difference comparing incidence between 2014 (0.41%, 95% CI, 0.24-0.63%) and 2017 (0.66%, 95% CI, 0.45-0.94%; P = 0.12). Most reactions (83.3%) involved multisystem anaphylaxis and roughly 40% were secondary to peanut or tree nut exposure. Epinephrine was administered in 88% of cases with 18% requiring hospital admission. In one of the first pediatric population incidence estimates, we report the proportion of AFARs requiring ED level care in children with established FA is low.