Emergency department childhood anaphylaxis presentations in regional/remote Australia

Abstract

Aim Explore the prevalence of childhood anaphylaxis and clinical presentation of anaphylaxis in children across two regional emergency departments over a 7‐year period. Methods Retrospective audit of all children (0–18 years) presenting to emergency from 1 January 2010 to 31 December 2016 with anaphylaxis, defined by Australasian Society of Clinical Immunology and Allergy definitions and doctor diagnosis. Results Seven hundred and twenty‐four patients were identified with allergic diagnosis, 60% were diagnosed with non‐anaphylaxis allergic reactions or unspecified urticaria and 40% with anaphylaxis (n = 286). Annual prevalence of anaphylaxis remained stable over the study period (M = 30.9/10 000 cases, range: 20.8–48.3/10 000). Gender distribution was equal, median age was 9.48 years (interquartile range = 4–15). Most (71%) arrived by private transport. 23% had a prior history of anaphylaxis. Food triggers (44%) were the most common cause of anaphylaxis. Insect bites/stings triggers occurred in 21%. Patients were promptly assessed (average wait time = 13 min), 16% received prior adrenaline injections. Adrenaline was administered in 26% and 20% were admitted to hospital. On discharge, 29% had a follow‐up plan, 9% received an allergy clinic referral, 6% anaphylaxis action plan, 26% adrenaline autoinjector prescriptions and allergy testing performed in 6%. Conclusions We found a relatively low prevalence of overall childhood anaphylaxis in a regional area. The two most common causes of anaphylaxis in this population (food and bites/stings) recorded increased prevalence providing an opportunity for further study. Significant gaps in evidence‐based care of anaphylaxis were noted, demonstrating the need for improved recognition and treatment guideline implementation in regional areas.

A retrospective audit of adult and paediatric anaphylaxis management from two Australian metropolitan mixed emergency departments

“…Corticosteroids were found to be the most administered treatment in our EDs, with over half of adult and paediatric patients receiving at least one dose. This corticosteroid use is similar to other Australian ED studies, with use reported to range from 44 to 87% [ 11 – 16 , 19 ]. The evidence supporting the routine use of corticosteroids in anaphylaxis management remains a subject of debate, with increasing evidence of no benefit in the acute management phase or in preventing biphasic reactions [ 20 ].…”

“…The identified rate of adrenaline administered to those presenting with anaphylaxis to ED in our study (57%) was within the range of 39% to 59% reported in previous studies [ 11 – 14 ]. Adrenaline is the first-line treatment for anaphylaxis and should be given without delay via the IM route [ 3 ].…”

“…Only two prior studies have evaluated AAP provision on discharge from ED following presentation for anaphylaxis. These observed large variation in rates of AAP provision on discharge of 6% and 41% respectively, with our study observing a rate of 31% [ 11 , 14 ]. Similar to AAI, presenting in business hours was also associated with increased likelihood of discharge with an AAP.…”

“…This is in line with Loprete, who reported 67.9% of their adult patients discharged with an AAI across a 10 year period in their single adult only ED [ 14 ]. However, other contemporary Australian studies undertaken in paediatric or mixed EDs have reported much lower rates of AAI provision on discharge ranging from 25 to 35% [ 11 – 13 ]. While subsided AAI prescriptions have been available since 2003 via the Pharmaceutical Benefit Scheme (PBS), an Australian Government program that subsidises the costs of medications for patients meeting eligibility criteria, ED doctors were unable to prescribe AAI for new anaphylaxis patients until 2006 [ 22 , 23 ].…”

“…To our knowledge, this is the largest contemporary study of both adult and paediatric anaphylaxis management and discharge care, conducted in Australia. Previous studies have predominantly examined care in either adult or paediatric patients and their respective ED settings, with the only studies examining care in this combined cohort restricted to fewer than 100 cases, did not examine provision of AAI or AAP on discharge or were conducted prior 2006, following which major changes were made to enable ED doctors to prescribe subsidised AAI for patients discharging with anaphylaxis [ 11 – 16 , 19 , 22 , 28 ].…”