Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)


Environmental, Occupational, and Geospatial Health Sciences


Glen Johnson

Committee Members

Jean Grassman

Michael Cassara

Timothy Li

Subject Categories

Environmental Health | Environmental Public Health | Other Immunology and Infectious Disease | Other Public Health | Patient Safety | Public Health


Allergic Reaction, Asthma, Cluster Analysis, Epinephrine, Emergency Medical Services (EMS), National Institute of Allergy and Infectious Disease (NIAID), Food Allergy and Anaphylaxis Network (FAAN), Food Allergy Research and Education (FARE)


Anaphylaxis is considered a severe, potentially fatal, systemic allergic reaction that occurs suddenly after contact with an allergy causing substance. It is estimated that up to 5% of the population has experienced anaphylaxis, with 1% of hospitalizations and 0.1% of emergency department patients having fatal outcomes. We characterized the population of patients encountered by the EMS agency (786 patients) that had a provider impression of “allergic reaction” and then utilized logistic regression models to estimate associations with the administration of epinephrine in the prehospital setting. Additionally, we used incident location data for all patient encounters of the EMS agency within the borough of Staten Island to calculate kernel density estimates for the geographic region, and then performed a cluster analysis of patients with a history of asthma or environmental allergy using census tracts as the unit of aggregation. Finally, we accessed records of patients specifically transported to Northwell facilities and applied a screen based upon NIAID/FAAN diagnostic criteria to identify potential cases of allergic reaction or anaphylaxis. These cases were then linked to hospital admission/discharge diagnoses for confirmation of the results of the screen.

Available for download on Monday, May 23, 2022