Background: Anaphylaxis is a life threatening hypersensitivity reaction. The diagnosis of anaphylaxis is not always easy to make in the pediatric emergency department (ED) setting. Therefore, children are often dangerously underdiagnosed and undertreated.
Objectives: To assess the incidence, triggers, and management of anaphylaxis in the Pediatric ED
Methods: a retrospective descriptive study of patients (16 years or younger) who presented with anaphylaxis between 2013 and 2014 in the pediatric ED of the Tel Aviv Sourasky Medical Center, which has an annual census of 28,000. The clinical features, causative agents, treatment and recommendations at discharge were recorded.
Results: During the study period, a total of 437 patients were diagnosed with an allergic or anaphylactic reaction. Of these 59 (13%) met the criteria for anaphylaxis but only 22 were correctly diagnosed. The mean age at presentation was 7 years, with a male predominance of 66%. Food was the most common causative agent (88%), specifically cow milk (33%) and treenuts (30%( prevailed. The majority of children presented with breathing difficulties (63%), followed by urticaria (59%). Twenty children (34%) were treated with IM adrenaline prior to ED arrival and only fifteen (25%) were treated with IM adrenaline in the ED. An adrenaline auto-injectorwas prescribed to 27% of the patients, and referral to an allergist was recommended to 46% of them.
Conclusion: The rate of anaphylaxis was 0.1% of all visits to the ED. Most cases of anaphylaxis were underdiagnosed, and undertreated. Many children were discharged without a prescription for an adrenaline auto-injector.
