708 Longitudinal Differences In Treatment Of Anaphylaxis Presenting To Pre-hospital Emergency Services In Rural Quebec Debanjana Das, MD, MBT 1 , Arjun Rash, MD 2 , Ann E. Clarke, MD, MSc, FRCPC 3 , Jocelyn Moisan 4 , Edmond S. Chan, MD, FAAAAI 5 , Har- ley Eisman, MD 6 , and Moshe Ben-Shoshan, MD, MSc 7 ; 1 Department of Family Medicine, McGill University, Montreal, QC, Canada, 2 McGill University Health Centre, Montreal, QC, Canada, 3 Division of Rheuma- tology, Department of Medicine, Cumming School of Medicine, Univer- sity of Calgary, Calgary, Alberta, Canada, Calgary, AB, Canada, 4 Directeur M edical R egional des Services Pr ehospitaliers D’urgence de L’Outaouais, Quebec, Canada, Gatineau, QC, Canada, 5 Division of Al- lergy & Immunology, Department of Pediatrics, Faculty of Medicine, Uni- versity of British Columbia, BC Children’s Hospital, Vancouver, British Columbia, Vancouver, BC, Canada, 6 Department of Emergency Medicine, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Montreal, QC, Canada, 7 Division of Pediatric Allergy and Clin- ical Immunololgy, Department of Pediatrics, Montreal Children’s Hospi- tal, Montreal, Quebec, Montreal, QC, Canada. RATIONALE: As part of the Cross-Canada-Anaphylaxis-Registry (C- CARE), we aimed to assess data collected prospectively over three years on pre-hospital anaphylaxis cases managed by paramedics in Outaouais, rural Quebec. METHODS: A software program prospectively recorded clinical char- acteristics and management of anaphylaxis cases. Univariate and multi- variate logistic regression were compared to identify factors associated with reaction severity and administration of epinephrine. RESULTS: Amongst a total of 101,136 ambulance calls of which 81,640 required transport, 345 cases of anaphylaxis were identified - 0.34% [95% CI, 30.1%, 38.0%] among all ambulance calls and 0.42% [95% CI, 38.0%, 47.0%] among those requiring transport. The median age among all cases was 47.3 years and 61.7% were females. Common triggers included food (36.8% [95% CI, 31.8%, 42.2%]), drugs, (22.0% [95% CI, 17.8%, 26.8%]) and venom (18.2%, [95% CI, 14.4, 22.8]). Older age, male gender and a venom trigger were associated with severe reactions [ORa51.0 (1.0,1.02), 2.0(1.2,3.3), and 2.0 (1.1,3.6) respectively]. Among all reactions, 28.1% [95% CI, 23.5, 33.2]) were severe, defined when hypotension or hypoxia (saturation < _92%) developed. Of patients with severe or moderate anaphylaxis (crampy abdominal pain/diarrhea/recurrent vomiting/dys- pnea/stridor/cough/wheeze), 21.5% [95 CI, 17.1, 26.8] were not admin- istered epinephrine. Cases in which antihistamines were given prior to paramedic arrival were more likely managed without epinephrine (odds ratio adjusted; ORa 52.0 [95% CI 1.2,3.4]). CONCLUSIONS: Given that antihistamines may mask symptoms but not stop the progression of anaphylaxis, the study highlights a need for increasing awareness among those delivering pre-hospital care regarding the recognition and appropriate use of epinephrine. 709 Disparities in Pre-Emergency Department Epinephrine and Antihistamine Use for Anaphylaxis Deepa Joshi, MD 1 , Jennifer Trainor, MD 1 , George Lales, MS-MIS 1 , Zachary Pittsenbarger, MD 1 , Marjorie Yarbrough, MPH 2 , Ruchi S. Gupta, MD, MPH 2,3 , and Bridget Smith, PhD 2,4 ; 1 Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 2 Northwestern University, Chicago, IL, 3 Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 4 Center for Innovation Complex Chronic Healthcare, VA, Chicago, IL. RATIONALE: Anaphylaxis is a potentially life-threating reaction requiring prompt treatment. Most pediatric patients present to the emergency department (ED) but factors that affect pre-ED administration of essential medications are not well understood. METHODS: One year after developing an ED reporting tool for anaphylaxis, we analyzed associations between patient characteristics and receipt of pre-ED epinephrine and diphenhydramine using descriptive statistics, chi-square tests, and Fischer’s exact tests. RESULTS: 209 cases were identified. Fewer Hispanic children received pre-ED epinephrine compared to other children (3.5% vs. 19.7%, p 50.002), while age, sex, and type of allergic exposure were not significantly different. Additionally, more white children received pre- ED epinephrine compared to children of color (23.0% vs. 8.3%, p 5 0.003). Children with Medicaid also received pre-ED epinephrine less compared to children with private insurance (2.1% vs. 19.6%, p 5 0.006). Children younger than 12 years of age received pre-ED diphenhydramine less compared to older children (26.6% vs. 52.9%, p50.001), while sex, race, and insurance type were not significantly different. Only 19.3% of Hispanic children received diphenhydramine compared to 38.2% of other kids (p50.01). CONCLUSIONS: In this cohort ethnicity, race, and insurance status were associated with pre-ED epinephrine use while ethnicity and age were associated with pre-ED diphenhydramine use. In an ED where greater than 50% of the population has Medicaid and/or is Hispanic, this study highlights striking disparities in pre-ED administration of potentially life-saving medications. 710 Serum tryptase levels among Brazilian patients: correlation with severity of anaphylaxis Luisa Karla P. Arruda, MD, PhD, FAAAAI 1 , Vinicius Aniceto 2 , Luana S. M. Maia, MSc 2 , and Janaina M. L. Melo, MD, PhD 2 ; 1 Ribeirao Preto Medical School - University of Sao Paulo, Ribeirao Preto, Brazil, 2 Ribeirao Preto Medical School - University of Sao Paulo, RIBEIRAO PRETO, Brazil. RATIONALE: A relationship of elevated serum basal tryptase(sBT) and severity of anaphylaxis, and association of high sBT with mastocytosis have been shown. Our aim was to correlate sBT level with severity of anaphylaxis and type of trigger factor among Brazilian patients. METHODS: Twenty-five patients (14 men) attending a hospital-based Allergy and Immunology Clinic were selected by having had at least one episode of anaphylaxis and were divided into 4 groups, according to the trigger factor responsible for their first episode of anaphylaxis: food, drugs, Hymenoptera venom and idiopathic. Ages varied from 5 to 67 years, with median of 26 years-old. sBT levels were assessed by the Immuno-CAP Tryptase immunoassay. According to signs and symptoms, the first anaphylactic episode was classified into four grades of severity (I-IV), ac- cording to Ring J et. Al, Lancet, 1977. RESULTS: Tryptase levels ranged from 2.74 to 8.58mg/L. There were no significant differences of sBT levels according to the trigger factor. Mean levels of sBT were: 5.38; 6.44; 4.85 and 4.53mg/L for patients who had anaphylaxis to foods, drugs, hymenoptera venom and idiopathic, respec- tively. Severity was classified as grade II (3 patients), III (17 patients) and IV (5 patients). Significantly lower levels of sBT were observed in patients with disease severity grades II/III, as compared to grade IV, with mean levels of 4.82 and 6.51mg/L, respectively (CI -2.94 to -0.31, p<0.05). CONCLUSIONS: Among Brazilian patients with anaphylaxis, higher sBT were found in patients with more severe anaphylaxis. None of the patients presented sBT levels which prompted us to investigate mastocytosis. J ALLERGY CLIN IMMUNOL VOLUME 139, NUMBER 2 Abstracts AB225 MONDAY