Spectrum of acute allergic diseases in an emergency department: An evaluation of one years’ experience

Abstract

Objective: There is limited available literature on the incidence of allergic diseases in ED. The objective of this study was to investigate the clinical records of patients admitted to the ED with a suspected allergic reaction. Methods: A 1 year retrospective study was carried out and data were collected from the patients’ computerized medical reports. Results: A total of 324 patients were admitted for an allergic event. Of those, 165 patients (50.9%) were female and their mean age was 55 ± 18.5 years. Diagnoses included: asthma in 100 patients (30.9%); hymenoptera allergy in 78 patients (24.1%); food allergy in 31 patients (9.5%); drug allergy in 25 patients (7.7%); and allergic conjunctivitis in 12 patients (3.7%). No diagnosis was found in the medical records of 78 patients (24.1%). Anaphylactic shock was observed in 12 patients (3.7%) with a diagnosis of food allergy (six cases), drug allergy (three cases) and hymenoptera allergy (three cases). Ninety patients (27.7%) were hospitalized in the following units: 38 in allergy unit (42.2%); 20 in intensive care unit (22.2%); 10 in pulmonary unit (11.1%); eight in the dermatology unit (8.9%); six in the internal medicine unit (6.7%); and eight in other units (8.9%). Overall, 42 patients (12.9%) were evaluated by an allergologist after ED discharge with positive allergy results in 28 cases (66.6%). Conclusions: Acute allergic diseases are not rare in ED, representing 1% of the annual visits in our series. A low rate of allergologist referral was observed. Emergency physicians must work closely with allergologists to ensure a better evaluation, long‐term care and preventive management of patients with allergic diseases admitted to the ED.

Emergency management of food allergy: systems perspective

“…In 2003, Bellou and colleagues [17] reviewed the charts of 324 patients in France admitted to the emergency department for an allergic event and found that 31 (9.5%) patients were diagnosed with food allergy. Six (19%) of the food-allergy patients were observed to have anaphylactic shock.…”

“…A prompt and accurate diagnosis to identify those at greatest risk for adverse outcomes is essential for effective emergency management [16]. Given such large variability in anaphylaxis estimates in the general population -and in the emergency department -and reports suggesting that the prevalence of allergies is rising [1,17], more work is needed develop clinical definitions that would allow for better measurement of the actual prevalence of food-related allergic reaction and anaphylaxis, and promote improved management of these problems in the emergency department.…”

Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature

“…Five studies found that few patients were referred to an allergist after being seen for an acute reaction in community or hospital clinics (35,43,71) or the ED (26,31). However, one study found that allergy testing and follow-up were more frequent in children attending hospital clinics (28).…”

Paediatric allergic reactions in the emergency department: a review

“…Although the emergency department (ED) plays a major role in the care of allergic disease,5 most studies to date have examined paediatric allergic reactions on an inpatient or outpatient basis or have focussed primarily on anaphylaxis 6 – 9. A recent study in Australia reviewed paediatric allergic reactions in the ED 10.…”