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Efficacy of high-dose inhaled salbutamol for the treatment of gastro-intestinal anaphylaxis.
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  • Cécile Frugier,
  • François Graham,
  • Kathryn Samaan,
  • Louis Paradis,
  • Anne Des Roches,
  • Philippe Bégin
Cécile Frugier
CHU Ste-Justine

Corresponding Author:[email protected]

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François Graham
Centre Hospitalier Universitaire Sainte-Justine
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Kathryn Samaan
CHU Ste-Justine
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Louis Paradis
Centre hospitalier de l'Université de Montréal, Hôpital St-Luc
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Anne Des Roches
Hopital Sainte-Justine
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Philippe Bégin
University of Montreal
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Background: Abdominal pain is a frequent symptom of IgE-mediated food allergy with limited therapeutic options. Visceral smooth muscle cell relaxation can be induced by activation of the beta-adrenergic receptors. Objective: To evaluate the efficacy of inhaled salbutamol empirically used to relieve abdominal pain caused by IgE-mediated allergic reactions at one center. Methods: All double-blind placebo-controlled food challenges to peanut performed at CHU Sainte-Justine between 2016 and 2020 were reviewed to identify patients that presented abdominal pain as part of their reaction. The primary outcome measure was the delay between the initiation of therapy and improvement of abdominal pain. It was compared between patients that had received inhaled salbutamol as part of their treatment and those that did not. Linear regression was performed to control for potential confounders. Results: During the study period, 174 positive DBPCFCs were performed, including 116 for peanut allergy. Of these, 77 presented abdominal pain and 49 met the criteria for inclusion in the study. Patients that received salbutamol improved significantly faster (median 14 minutes; range 5-66) than those that did not (61 minutes range 5-194) (p<0.0001). In the linear regression, only the administration of salbutamol and emesis were found to independently accelerate the recovery of abdominal pain, each reducing the time to improvement by an average of 61 ±10 minutes (p<0.0005) and 44 ±13 minutes (p<0.0005), respectively. Conclusion: This retrospective study provides low-quality evidence of a large effect for salbutamol in the treatment of gastro-intestinal anaphylaxis. Further investigation in randomized controlled trials would be warranted.