Canadian Anaphylaxis Network- Predicting Recurrence After Emergency Presentation for Allergic REaction

Summary

BACKGROUND: Anaphylaxis is the most severe form of allergy that rapidly affects multiple body systems and can be deadly. The highest incidence of anaphylaxis is in children and adolescents. In Canada, approximately every 10 minutes there is an Emergency Department (ED) visit for food allergy, and up to 80% of anaphylactic reactions in children are triggered by food. The ambiguity in how physicians manage anaphylaxis adds a huge burden to health care and further contributes to ED crowding. Current Canadian and international treatment guidelines universally recommend that all patients present to the ED for a prolonged period (6-24 hours) of in-hospital monitoring after initial reactions have been treated, to increase detection of biphasic anaphylaxis (BA). BA is a second wave of symptoms after initial resolution. These guidelines are based on poor or little evidence and have unintended negative impacts on patient safety and quality of life. Furthermore, this 'one-size fits all' approach to care leads to wasteful resource utilization that provides low value care.

OBJECTIVE: The main objective of the study is to derive a clinical prediction rule that identifies children with anaphylaxis who are at risk of BA.

METHODS: This prospective multicenter cohort study will enroll 1682 patients from 7 pediatric EDs that are members of the Pediatric Emergency Research Canada (PERC) network. We will enroll patients \< 18 years of age presenting to the ED with an allergic reaction that matches the diagnostic criteria of anaphylaxis. Research assistants (RA) present in the ED will screen, obtain consent, and prospectively collect all study data. The Research Assistant or Research Nurse will follow patients during their ED visit and ascertain, in conjunction with the medical team, if the patient developed biphasic anaphylaxis in the ED. A standardized follow-up survey conducted within 2-5 days of ED or hospital discharge will determine if a biphasic reaction occurred following ED disposition. We established an advisory council comprised of end-users and community partners external to the project team to monitor project milestones.

STUDY TEAM: We have established an international multidisciplinary team of experts in pediatrics, emergency medicine, allergy/immunology, research methodology and statistics, and knowledge translation. Our team is supported by the PERC network.

EXPECTED OUTCOME: Providing the best evidence-based, value care at the lowest cost is a moral and ethical imperative. Therefore, in alignment with national and international research priorities, we propose to develop a robust prediction model for BA. This model will address a significant gap in current knowledge and practice, with anticipated benefit for patient care and health system efficiency worldwide. This trial will generate novel, clinically relevant data on optimal ED management of children with anaphylaxis that integrates best value care with patient safety.

Conditions

• Anaphylaxis

Interventions

OTHER

Observational

Not applicable - observational study

Sponsors & Collaborators

• Stollery Children's Hospital

  collaborator OTHER

• Children's Hospital of Western Ontario

  collaborator OTHER

• The Hospital for Sick Children

  collaborator OTHER

• Alberta Children's Hospital

  collaborator OTHER

• McMaster University

  collaborator OTHER

• CHU Ste-Justine, Montreal

  collaborator UNKNOWN

• Canadian Institutes of Health Research (CIHR)

  collaborator OTHER_GOV

• Waleed Alqurashi

  lead OTHER

Principal Investigators

• Waleed Alqurashi, MD · Children's Hospital of Eastern Ontario

• Amy C Plint, MD · Children's Hospital of Eastern Ontario

• Marcus S Shaker, MD · Dartmouth-Hitchcock Medical Center

Eligibility

Max Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2022-04-11

Primary Completion

2025-04-16

Completion

2025-12-31

Countries

• Canada

Study Locations