Coleman J1, Drought J2, Bolger T1
1.Department of Emergency Paediatrics, CHI @ Tallaght University Hospital 2.Trinity College Dublin
Title: The Treatment and outcomes of patients presenting with Allergy to the paediatric emergency care unit a Tertiary Irish Centre
Biography
Biography: Coleman J1, Drought J2, Bolger T1
Abstract
Background
Presentations of allergies are becoming an increasing burden in Ireland with up 4% of Irish children now suffering from a food allergy
(1). Despite this, few studies have evaluated the outcome of allergy presentations to the emergency department
(2) and most existing literature focuses on anaphylaxis outcomes
(3). Outcomes can be dictated by management in the emergency department.
AIM
- To identify the common allergens presenting to the unit.
- To evaluate treatment, outcomes and follow-up of patients presenting with allergy to the emergency care unit.
Methods
- A retrospective chart audit focusing on clinically confirmed allergy diagnosis to the department over a 6 month period from 1st March 2021 to 30th September 2021. Patient records were accessed electronically through local software.
Results - Demographics
- There was 76 eligible patients included.
- The median age of presentation was 3.
- 50% male and 50% female patients
- 44% a documented history of ad eczema.
- 28% of patients had other known allergens. 3
- 5% of patients had a family history of allergy.
Results – Presentations
- The common allergens included food (70%), environmental (18%) and other (12%).
- The most common food allergens were tree nuts representing 15 of the 53 (28%) food allergens, peanuts 12 (22%) and eggs 8 (15%).
- There were 2 suspected shellfish allergies and 1 suspected fish. 2 patients reacted to mango.
- 6 presentations were caused by anaphylaxis (8%). These did not require inpatient admission.
- 1 patient presented with serum sickness and this was the only admission.
Results – Outcomes
- 87% required acute treatment with antihistamines, 12% with steroids and 7% with adrenaline.
- 26% were prescribed or already had discharge adrenaline auto-injectors.
- 74% were prescribed a discharge antihistamine and 7% were discharged on oral steroids.
Results – Follow Up
- Advice resources were documented in 23%. The most common sources were other health care professionals (allergy nurse, GP, pharmacy).
- 39% of patients were newly referred to an allergist. 11% were known allergy patients. 11% were referred for GP follow up and 39% had no follow up arranged.
- In 22% of cases exclusion or reintroduction advice was formally documented.
Conclusion
-
The majority of allergy presentations to our department were related to food allergens.
Nuts including peanuts and tree-nuts appear to account for a large portion of food allergens (50%) and indicative of the more severe symptoms experienced in these cases. - A large proportion of treatments involved antihistamines or no treatment at all and were managed in the ED, with a very low admission rate.
References:
-
Irish Food Allergy Network (IFAN), Online publication, Accessed from http://ifan.ie/childcare-schools, Sept 2021
2.) Melville N, Beattie T, Paediatric allergic reactions in the emergency department: a review, Emergency Medicine Journal 2008;25:655-658.
3.) Braganza SC, Acworth JP, Mckinnon DR, Peake JE, Brown AF. Paediatric emergency department anaphylaxis: different patterns from adults. Archives of Disease in Childhood. 2006 Feb;91(2):159-163. DOI: 10.1136/adc.2004.069914.