Grant: Project Grant

Anaphylaxis, the most severe manifestation of an allergic reaction, is increasing in children, resulting in an increase in emergency department visits. Our team has conducted the first Canadian assessment of the prevalence of food allergy revealing that 8% of Canadians have a food allergy, thus at risk of anaphylaxis. Given that the only treatment for anaphylaxis is prompt epinephrine (EAI) administration, it is essential to evaluate current laws, policies and guidelines and develop rectifying strategies for EAI underutilization in the pre-hospital setting. Anaphylaxis carries a substantial cost to patients and the health care system. Costs of anaphylaxis have been estimated at $1 billion annually; direct expenditures of $294 million for epinephrine rescue medication and indirect costs of $609 million annually. PLEDGE (Policies Laws and Emergency Department Guidelines for Epinephrine auto-injector use), a proposed research program, will be the first to strategically examine the following 5 aims: 1: Assess the difference between EAI at school versus restaurants/home and between Ontario and other Canadian provinces that do not have anaphylaxis legislation. 2: Develop a model to assess the cost-effectiveness of revised anaphylaxis policies. 3: Compare the use of steroids and epinephrine in children treated with epinephrine and not transferred to the ED versus those treated with epinephrine and transferred to the ED. 4: Conduct a qualitative assessment of the causes of EAI utilization and underutilization. 5: Conduct a workshop to translate our findings, guided by a quality improvement theory, to the development of revised anaphylaxis guidelines. Through two established registries, a pan-Canadian collaboration anaphylaxis registry (C-CARE) and Oral ImmunoTherapy (OIT) registry, PLEDGE will put in place revised anaphylaxis management guidelines that will be highly valuable to those suffering from allergies, as well as Canada's communities and the healthcare system.