Allergy alerts — The incidence of parentally reported allergies in children presenting for general anesthesia

Abstract

Summary Background and aim Pediatric patients increasingly report allergies, including allergies to food and medications. We sought to determine the incidence and, nature of parent‐reported allergies in children presenting for surgery and its significance for anesthetists. Methods We prospectively collected data on admissions through our surgical admission unit over a 2‐month period at a pediatric tertiary care teaching hospital. Data collected included patient demographics, history of atopy, with more comprehensive information collected if an allergy was reported. A clinical immunologist and an anesthetist reviewed the documentation of all patients reporting an allergy. Results We reviewed 1001 pediatric patients, 158 (15.8%) patients with parent‐reported allergies; to medications/drugs (n = 73), food (n = 66), environmental allergens (dust/grasses, n = 35), tapes/dressings (n = 27), latex (n = 4), and venom (eg, bee, wasp, n = 9). Forty‐one patients reported antibiotic allergies, with Beta‐lactam antibiotics being the most common, with the majority presenting with rash alone (57%). Ten patients reported allergies to nonsteroidal anti‐inflammatory drugs and eight to opioids. Twenty‐four patients reported egg and/or peanut allergy. Only 3/1001 (0.3%) patients were deemed to have evidence of likely IgE‐mediated drug allergy. Of the reported allergies, only 60 (38.2%) had been investigated prior, most likely to be followed up were food (53%) and environmental allergies (44.4%). Only 4/73 (5.5%) reported medication allergies had further follow‐up. Just four patients (0.4% of the entire cohort) had drug sensitivities/allergies that were likely to majorly alter anesthesia practice. Conclusion Only the minority of parent‐reported allergies in pediatric surgical patients were specialist confirmed and likely to be clinically relevant. Self‐reported food allergy is commonly specialist verified whereas reactions to medications were generally not. Over‐reporting of allergies is increasingly common and limits clinician choice of medications. Better education of patients and their families and more timely verification or dismissal of parent‐reported reactions is urgently needed.

Recent developments and highlights in drug hypersensitivity

“…45,52 Parentally reported allergies in children are also important, indicating the need for a better training of families and verification by physicians. 53 Discrepancies on diagnosis have been observed among different specialists with an over-diagnosis in Emergency Department, being only 39% of cases confirmed by Allergy Department; on the contrary, under-diagnosis of anaphylaxis was detected in Emergency Department. 54 This has been issued in an EAACI task force considering a clear need for educational programmes to train primary care and Emergency Department physicians in DHRs as they are often the first point of contact for allergic patients.…”

An update on allergy and anaphylaxis in pediatric anesthesia

“…9 There is limited data for the prevalence of drug allergy labeling in children, however recent studies from Western Australia quoted a rate of 5%-7% at a tertiary pediatric centre. 9,10 Up to 20% of adult inpatients are labeled as having antibiotic allergy, 11,12 with only 10% of those patients having a true allergy. 12 Having an antibiotic allergy label is associated with inappropriate antibiotic prescribing 11 and increased hospital readmission compared to unlabeled patients.…”

“…Children are frequently labeled as having multiple drug allergies without definitive testing . There is limited data for the prevalence of drug allergy labeling in children, however recent studies from Western Australia quoted a rate of 5%‐7% at a tertiary pediatric centre . Up to 20% of adult inpatients are labeled as having antibiotic allergy, with only 10% of those patients having a true allergy .…”

Food, fads, allergies and anaphylaxis with propofol

“…Sommerfield et al. have looked at the prevalence of food allergies in children presenting to a children's teaching hospital in Perth, Western Australia. Twenty‐four of 1001 children reported egg and/or peanut allergy.…”

“…The prevalence of these food allergies in children remains uncertain due to allergy definition, severity of reaction differences, study population characteristics and a focus on specific foods. Sommerfield et al [3] have looked at the prevalence of food allergies in children presenting to a children's teaching hospital in Perth, Western Australia.…”