Paediatric emergency department anaphylaxis: different patterns from adults

S C Braganza, D R L Mckinnon, A F T Brown, Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia

J P Acworth, Department of Emergency Medicine, Royal Children's Hospital, Herston, Brisbane, Australia

J E Peake, University Department of Paediatrics and Child Health, Royal Children's Hospital, Herston, Brisbane, Australia

Correspondence to: Associate Professor A F T Brown
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland 4029 Australia; af.brown@uq.edu.au

S C Braganza, D R L Mckinnon, A F T Brown, Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, AustraliaJ P Acworth, Department of Emergency Medicine, Royal Children's Hospital, Herston, Brisbane, AustraliaJ E Peake, University Department of Paediatrics and Child Health, Royal Children's Hospital, Herston, Brisbane, AustraliaCorrespondence to: Associate Professor A F T Brown
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland 4029 Australia; af.brown@uq.edu.au

Accepted 2005 Jun 17.

Abstract

Background and Aims

Data on acute paediatric anaphylaxis presentations to the emergency department (ED) are limited. All allergic presentations to one Australian paediatric ED were studied to determine epidemiological, clinical, and outcome data.

Methods

Retrospective, case based study of patients under 16 years attending one metropolitan, paediatric teaching hospital ED in Australia over three years. The medical records of patients presenting with generalised allergic reactions and anaphylaxis satisfying relevant ICD‐9‐CM diagnostic codes were studied. The incidence, age, sex ratio, co‐morbidities, likely aetiology, clinical features, management, and disposal were determined.

Results

A total of 526 children with generalised allergic reactions, and 57 with anaphylaxis were included in the study. This represented incidences of 9.3:1000 ED presentations for generalised allergic reactions and 1:1000 for anaphylaxis. There were no fatalities. In anaphylaxis cases, a cause was recognised in 68.4%. Cutaneous features were present in 82.5%. A past history of asthma was reported in 36.8%. Adrenaline was used in 39.3% of severe anaphylaxis cases. The ED alone definitively cared for 97.8% of all patients. Follow up was inadequate in cases of anaphylaxis.

Conclusions

This is the first reported incidence figure for paediatric anaphylaxis ED presentations in Australia, and is less than that reported in adults in the same local population. However, the incidence of generalised allergic reactions of 9.3:1000 was greater than in the adults. Virtually all paediatric allergic cases may be managed in the ED alone, provided that the importance of specialist follow up, particularly for severe anaphylaxis, is recognised.

Keywords: anaphylaxis, epidemiology, epinephrine, adrenaline, angioneurotic oedema, angioedema, immediate hypersensitivity

Abstract

Although the term anaphylaxis was introduced as far back as 1902 by Portier and Richet,¹ the definition continues to be contentious. A recent guideline from the Anaphylaxis Working Party of the Australasian Society of Clinical Immunology and Allergy Inc. (ASCIA) defined anaphylaxis as “a rapidly evolving generalised multi‐system allergic reaction characterised by one or more symptoms or signs of respiratory and/or cardiovascular involvement, and involvement of other systems such as the skin and/or gastrointestinal tract”.² ASCIA also defined a generalised allergic reaction as “one or more symptoms or signs of skin and/or gastrointestinal tract involvement without respiratory and/or cardiovascular involvement”.²

There are few data on the emergency department (ED) incidence of this potentially fatal condition, especially in the paediatric population. Most previous paediatric anaphylaxis studies have been based on hospital admissions or in outpatient allergy clinics rather than children presenting to the ED.³⁴

We describe the epidemiology, aetiology, clinical features, and management of patients presenting with generalised allergic reactions or anaphylaxis to one Australian paediatric emergency department during a three year period. The purpose of the study was to describe how undifferentiated paediatric patients present with acute allergic and systemic hypersensitivity reactions and to determine if they differ from allergic reactions and anaphylaxis in adult emergency patients.

Abbreviations

ED - emergency department

GAR - generalised allergic reaction

Abbreviations

Footnotes

Competing interests: none

Footnotes

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